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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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Family of man who committed murder after escaping from mental health unit say they were ‘failed’ by NHS trust

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Family of man who committed murder after escaping from mental health unit say they were 'failed' by NHS trust

The family of a man who committed murder during an escape from a secure mental health unit have told Sky News they were “failed” by the trust that was meant to be caring for him.

Joshua Carroll is currently waiting to be sentenced for the murder of Headley Thomas, known as Barry, after beating him to death in a park in Trafford, Manchester, in September 2022.

At the time of the attack, Joshua was in the care of Greater Manchester Mental Health Trust (GMMH). He was being treated as an inpatient at Park House, a unit which has now closed down.

Joshua’s mum and sister say he escaped from the unit 21 times – and they repeatedly complained to the trust and asked for help.

Headley Barry Thomas
Image:
Headley Thomas, who was known as Barry

Leanne Carroll, Joshua’s sister, told Sky News: “The night it happened, Joshua had come to my house. And it was just a normal ‘oh Joshua has escaped from hospital again’. Nothing appeared any different.”

She says they didn’t find out about what had happened until Joshua was arrested weeks later – and “everything fell apart from there”.

Julie and Leanne Carroll
Image:
Julie and Leanne Carroll

“My heart broke,” said Joshua’s mum, Julie Carroll. “It’s just a horrible, horrible situation.”

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Joshua had been diagnosed with conditions including schizoaffective disorder, and had been in and out of inpatient care for around 15 years, his family said.

They showed me more than 20 pages of complaints and responses from GMMH about his repeated escapes, dating back eight years before the murder.

After Joshua’s fourth escape from Park House, his family asked for him to be moved to another unit, saying they were concerned about security.

This didn’t happen, with the trust citing capacity issues. His family complained once again about his escapes just five weeks before the murder, in August 2022.

“We are very, very angry and disappointed,” said Julie. “You think if your child is in hospital, and they are very poorly, that they are going to be looked after – they will be safe and they will be secure. But that wasn’t the case for Josh.”

Julie Carroll
Image:
Julie Carroll says her “heart broke” after her son’s crime came to light

Although Joshua was convicted of murder, Leanne says his family hold GMMH partly responsible.

“If you had done your job properly – none of this would have happened,” she said. “Two families wouldn’t have been destroyed and so many hearts wouldn’t have been broken.”

Since 2022, GMMH has been served with several Section 29A warning notices by the Care Quality Commission. These are issued when the commission decides a service needs to make significant improvements, and there is a risk of harm.

In the case of GMMH, their concerns included “ward security systems not consistently keeping people safe”.

Dr John Mulligan is a clinical psychologist for GMMH, working in the community for the early intervention in psychosis service, and a representative for the union Unite.

Dr John Mulligan is
Image:
Dr John Mulligan

He and his colleagues have been going on strike repeatedly across the past seven months, saying they just don’t have the staffing levels they need to keep people safe.

“Thankfully, violent incidents among our service users are quite rare, they are much more likely to be the victims of violence and aggression,” he said. “But serious incidents are happening regularly. Far too regularly.

“It’s very upsetting for staff and for patients and families.”

Joshua Carroll mug shot Pic: Greater Manchester Police
Image:
Joshua Carroll . Pic: Greater Manchester Police

Salli Midgley, chief nurse at the Greater Manchester Mental Health NHS Foundation Trust said: “On behalf of GMMH, we express our heartfelt condolences to Headley Thomas’s loved ones at this very sad time.

“Our thoughts and sympathies remain with everyone who has been affected by this most devastating incident. We are deeply sorry that it happened while Joshua Carroll was under our care.

“Under the trust’s new leadership, we have been working closely with NHS England, our commissioners and the CQC to create better, safer and well-led services for all.”

Notes the Carroll family have kept about their complaints
Image:
The Carroll family asked for Joshua to be moved to a different unit after his escapes

She continued: “A huge amount of progress has already been made but we know we still have a lot to do to improve our services.

“As part of this work, we are currently carrying out an in-depth investigation into the care and treatment provided to Mr Carroll, and the circumstances leading to Mr Thomas’ death, the findings of which will be shared with NHS England.

“We are unable to comment further on this case whilst the investigation is ongoing.”

Barry Thomas’s family told Sky News mental health is a very serious issue – but they believe Joshua Carroll tried to “play down his actions”.

They said: “Let’s all remember that a life was taken. Our brother, father, and uncle. The evidence the police gathered was in plain sight for all to see.

“We, the family, would like to thank all the police involved for the work they have done, in bringing justice for Barry.”

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Hashem Abedi: Manchester bomb plotter moved back to Belmarsh prison after guards attacked in jail in Durham

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Hashem Abedi: Manchester bomb plotter moved back to Belmarsh prison after guards attacked in jail in Durham

The Manchester Arena bomb plotter Hashem Abedi has been moved back to Belmarsh prison after an alleged attack at HMP Frankland on Saturday.

Three prison officers at the high-security jail in County Durham were attacked with cooking oil before being stabbed with an improvised weapon.

Abedi has been transferred to Belmarsh prison in southeast London where he’d previously been found guilty of attacking a prison officer in 2020, along with two other convicted terrorists.

Belmarsh is considered the most high-security prison in the UK.

Abedi has been moved to the only available highly-controlled ‘suite’ cell in the country – a standalone self-contained unit monitored by a minimum of five people at any one time, and a prison dog.

There are only four such cells across England and Wales.

Abedi was convicted of assisting the Manchester terror plot, in which his brother Salman Abedi killed himself and 22 other people by detonating a bomb in a rucksack at an Ariana Grande concert in May 2017.

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Hashem Abedi was sentenced in 2020 to at least 55 years in prison after being found guilty of 22 counts of murder over the atrocity.

Salman Abedi killed 22 innocent people
Image:
Salman Abedi before the concert attack. File pic: PA

Meanwhile, the government has said it will commission a review into the incident at HMP Frankland, after suspending access to cooking facilities in separation units, which is where the alleged attack took place.

Sky News understands the Prison Officers Association, after visiting staff who were on duty at the category A jail this week, have written to Prime Minister Sir Keir Starmer calling for urgent action in order to protect prison staff in the high-security estate.

The union wants to see prison officers working there given stab-proof vests, access to tasers in certain situations, and not just a suspension of self cooking facilities in separation units but a full ban.

Separation units house the country’s most dangerous and violent criminals.

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Belmarsh prison
Image:
Belmarsh prison in southeast London. File pic: PA

There have been a series of violent attacks across prisons in England and Wales, only days apart.

On Sunday, convicted killer John Mansfield was found dead at a category A prison, HMP Whitemoor, in Cambridgeshire. Police said they arrested a 44-year-old man on suspicion of murder.

Sky News also understands there was an incident on Tuesday lunchtime at HMP Lowdham Grange in Nottinghamshire.

A specialist ‘response group’ consisting of officers from outside the prison were deployed to bring the situation under control, along with a ‘hostage’ situation, while prisoners climbed on the roof and netting. The situation was brought under control within an hour.

Prisons minister Lord Timpson said it was “another sign of the problems we are facing in our prison with prisons that are overcrowded and violent”.

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More than 1,000 miles of roadworks lifted to allow ‘smooth’ Easter getaway

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More than 1,000 miles of roadworks lifted to allow 'smooth' Easter getaway

More than 1,000 miles of roadworks are set to be lifted in England to allow for millions of motorists to have a “smooth” journey over the Easter holidays.

Roadworks from 1,127 miles of motorways and major A roads will be removed by National Highways from 6am on Thursday, meaning 97.5% of its network will be free of traffic cones.

The roadworks will only be reintroduced after Easter Monday.

According to the AA, an estimated 19.1 million people in the UK will drive on Good Friday, along with 18.5 million hitting the road on Saturday and 18.2 million on Easter Sunday and Easter Monday respectively.

National Highways director of operational services, Andrew Butterfield, said: “We expect the roads to be busy with people looking to make the most of a long Easter weekend.

“That’s why we are making journeys easier by removing a huge number of roadworks.”

Despite that the RAC warned that drivers face a “hat-trick of hold-ups” on Thursday, Good Friday and Saturday as families try to get the most out of the end of the school holidays for many.

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‘Plan ahead’

Mr Butterfield urged motorists to “take time to plan ahead” as he said: “Two of the top three causes of breakdowns are tyre issues and empty fuel tanks.

“You can help prevent any breakdowns by following our advice: top up your fuel, oil and screen wash, plan your journey, check your tyres and prepare for all weather conditions.”

Read more from Sky News:
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Do not eat a whole Easter egg in one go, NHS doctor urges

Transport Secretary Heidi Alexander said: “Cutting journey times and saving drivers money every year is all part of our Plan for Change to raise living standards and put more money in people’s pockets.

“We are tackling the real problems that drivers face by lifting 1,127 miles of roadworks over Easter and cracking down on disruptive streetworks to make journeys to see loved ones as smooth as possible.”

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