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.
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.
Ava was heading home from Pizza Hut when she found out her dad had been arrested.
Warning: This article includes references to indecent images of children and suicide that some readers may find distressing
It had been “a really good evening” celebrating her brother’s birthday.
Ava (not her real name) was just 13, and her brother several years younger. Their parents had divorced a few years earlier and they were living with their mum.
Suddenly Ava’s mum, sitting in the front car seat next to her new boyfriend, got a phone call.
“She answered the phone and it was the police,” Ava remembers.
“I think they realised that there were children in the back so they kept it very minimal, but I could hear them speaking.”
“I was so scared,” she says, as she overheard about his arrest.
Image: ‘Ava’ says she was ‘repulsed’ after discovering what her dad had done
“I was panicking loads because my dad actually used to do a lot of speeding and I was like: ‘Oh no, he’s been caught speeding, he’s going to get in trouble.'”
But Ava wasn’t told what had really happened until many weeks later, even though things changed immediately.
“We found out that we weren’t going to be able to see our dad for, well we didn’t know how long for – but we weren’t allowed to see him, or even speak to him. I couldn’t text him or anything. I was just wondering what was going on, I didn’t know. I didn’t understand.”
Ava’s dad, John, had been arrested for looking at indecent images of children online.
We hear this first-hand from John (not his real name), who we interviewed separately from Ava. What he told us about his offending was, of course, difficult to hear.
His offending went on for several years, looking at indecent images and videos of young children.
His own daughter told us she was “repulsed” by what he did.
But John wanted to speak to us, frankly and honestly.
He told us he was “sorry” for what he had done, and that it was only after counselling that he realised the “actual impact on the people in the images” of his crime.
By sharing his story, he hopes to try to stop other people doing what he did and raise awareness about the impact this type of offence has – on everyone involved, including his unsuspecting family.
John tells us he’d been looking at indecent images and videos of children since 2013.
“I was on the internet, on a chat site,” he says. “Someone sent a link. I opened it, and that’s what it was.
“Then more people started sending links and it just kind of gathered pace from there really. It kind of sucks you in without you even realising it. And it becomes almost like a drug, to, you know, get your next fix.”
John says he got a “sexual kick” from looking at the images and claims “at the time, when you’re doing it, you don’t realise how wrong it is”.
‘I told them exactly what they would find’
At the point of his arrest, John had around 1,000 indecent images and videos of children on his laptop – some were Category A, the most severe.
Referencing the counselling that he since received, John says he believes the abuse he received as a child affected the way he initially perceived what he was doing.
“I had this thing in my mind,” he says, “that the kids in these were enjoying it.”
“Unfortunately, [that] was the way that my brain was wired up” and “I’m not proud of it”, he adds.
John had been offending for several years when he downloaded an image that had been electronically tagged by security agencies. It flagged his location to police.
John was arrested at his work and says he “straight away just admitted everything”.
“I told them exactly what they would find, and they found it.”
The police bailed John – and he describes the next 24 hours as “hell”.
“I wanted to kill myself,” he remembers. “It was the only way I could see out of the situation. I was just thinking about my family, my daughter and my son, how is it going to affect them?”
But John says the police had given information about a free counselling service, a helpline, which he called that day.
“It stopped me in my tracks and probably saved my life.”
Image: ‘John’ thinks children of abusers should get more support
‘My world was crumbling around me’
Six weeks later, John was allowed to make contact with Ava.
By this point she describes how she was “hysterically crying” at school every day, not knowing what had happened to her dad.
But once he told her what he’d done, things got even worse.
“When I found out, it genuinely felt like my world was crumbling around me,” Ava says.
“I felt like I couldn’t tell anyone. I was so embarrassed of what people might think of me. It sounds so silly, but I was so scared that people would think that I would end up like him as well, which would never happen.
“It felt like this really big secret that I just had to hold in.”
“I genuinely felt like the only person that was going through something like this,” Ava says.
She didn’t know it then, but her father also had a sense of fear and shame.
“Youcan’t share what you’ve done with anybody because people can get killed for things like that,” he says.
“It would take a very, very brave man to go around telling people something like that.”
And as for his kids?
“They wouldn’t want to tell anybody, would they?” he says.
For her, Ava says “for a very, very long time” things were “incredibly dark”.
“I turned to drugs,” she says. “I was doing lots of like Class As and Bs and going out all the time, I guess because it just was a form of escape.
“There was a point in my life where I just I didn’t believe it was going to get better. I really just didn’t want to exist. I was just like, if this is what life is like then why am I here?”
Image: Professor Armitage says children of abusers should be legally recognised as victims
‘The trauma is huge for those children’
Ava felt alone, but research shows this is happening to thousands of British children every year.
Whereas suspects like John are able to access free services, such as counselling, there are no similar automatic services for their children – unless families can pay.
Professor Rachel Armitage, a criminology expert, set up a Leeds-based charity called Talking Forward in 2021.
It’s the only free, in-person, peer support group for families of suspected online child sex offenders in England. But it does not have the resources to provide support for under-18s.
“The trauma is huge for those children,” Prof Armitage says.
“We have families that are paying for private therapy for their children and getting in a huge amount of debt to pay for that.”
Prof Armitage says if these children were legally recognised as victims, then if would get them the right level of automatic, free support.
It’s not unheard of for “indirect” or “secondary” victims to be recognised in law.
Currently, the Domestic Abuse Act does that for children in a domestic abuse household, even if the child hasn’t been a direct victim themselves.
In the case of children like Ava, Prof Armitage says it would mean “they would have communication with the parents in terms of what was happening with this offence; they would get the therapeutic intervention and referral to school to let them know that something has happened, which that child needs consideration for”.
We asked the Ministry of Justice whether children of online child sex offenders could be legally recognised as victims.
“We sympathise with the challenges faced by the unsuspecting families of sex offenders and fund a helpline for prisoners’ families which provides free and confidential support,” a spokesperson said.
But when we spoke with that helpline, and several other charities that the Ministry of Justice said could help, they told us they could only help children with a parent in prison – which for online offences is, nowadays, rarely the outcome.
None of them could help children like Ava, whose dad received a three-year non-custodial sentence, and was put on the sex offenders’ register for five years.
“These children will absolutely fall through the gap,” Prof Armitage says.
“I think there’s some sort of belief that these families are almost not deserving enough,” she says. “That there’s some sort of hierarchy of harms, and that they’re not harmed enough, really.”
Image: ‘Ava’ started taking drugs after her dad’s arrest and ‘didn’t want to exist’
‘People try to protect kids from people like me’
Ava says there is simply not enough help – and that feels unfair.
“In some ways we’re kind of forgotten about by the services,” she says. “It’s always about the offender.”
John agrees with his daughter.
“I think the children should get more support than the offender because nobody stops and ask them really, do they?” he says.
“Nobody thinks about what they’re going through.”
Although Ava and John now see each other, they have never spoken about the impact that John’s offending had on his daughter.
Ava was happy for us to share with John what she had gone through.
“I never knew it was that bad,” he says. “I understand that this is probably something that will affect her the rest of her life.
“You try to protect your kids, don’t you. People try to protect their kids from people like me.”
Anyone feeling emotionally distressed or suicidal can call Samaritans for help on 116 123 or email jo@samaritans.org in the UK. In the US, call the Samaritans branch in your area or 1 (800) 273-TALK.
MasterChef presenter John Torode will no longer work on the show after an allegation he used an “extremely offensive racist term” was upheld, the BBC has said.
His co-host Gregg Wallace was also sacked last week after claims of inappropriate behaviour.
On Monday, Torode said an allegation he used racist language was upheld in a report into the behaviour of Wallace. The report found more than half of 83 allegations against Wallace were substantiated.
Torode, 59, insisted he had “absolutely no recollection” of the alleged incident involving him and he “did not believe that it happened,” adding “racial language is wholly unacceptable in any environment”.
Image: John Torode and Gregg Wallace in 2008. Pic: PA
In a statement on Tuesday, a BBCspokesperson said the allegation “involves an extremely offensive racist term being used in the workplace”.
The claim was “investigated and substantiated by the independent investigation led by the law firm Lewis Silkin”, they added.
“The BBC takes this upheld finding extremely seriously,” the spokesperson said.
“We will not tolerate racist language of any kind… we told Banijay UK, the makers of MasterChef, that action must be taken.
“John Torode’s contract on MasterChef will not be renewed.”
Australian-born Torode started presenting MasterChef alongside Wallace, 60, in 2005.
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1:11
Why Gregg Wallace says he ‘will not go quietly’
A statement from Banijay UK said it “takes this matter incredibly seriously” and Lewis Silkin “substantiated an accusation of highly offensive racist language against John Torode which occurred in 2018”.
“This matter has been formally discussed with John Torode by Banijay UK, and whilst we note that John says he does not recall the incident, Lewis Silkin have upheld the very serious complaint,” the TV production company added.
“Banijay UK and the BBC are agreed that we will not renew his contract on MasterChef.”
Earlier, as the BBC released its annual report, its director-general Tim Davie addressed MasterChef’s future, saying it can survive as it is “much bigger than individuals”.
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3:30
BBC annual report findings
Speaking to BBC News after Torode was sacked, Mr Davie said a decision is yet to be taken over whether an unseen MasterChef series – filmed with both Wallace and Torode last year – will be aired.
“It’s a difficult one because… those amateur chefs gave a lot to take part – it means a lot, it can be an enormous break if you come through the show,” he added.
“I want to just reflect on that with the team and make a decision, and we’ll communicate that in due course.”
Mr Davie refused to say what the “seriously racist term” Torode was alleged to have used but said: “I certainly think we’ve drawn a line in the sand.”
In 2022, Torode was made an MBE in the Queen’s Birthday Honours, for services to food and charity.
An inquiry into the case of a hospital worker who sexually abused dozens of corpses has concluded that “offences such as those committed by David Fuller could happen again”.
It found that “current arrangements in England for the regulation and oversight of the care of people after death are partial, ineffective and, in significant areas, completely lacking”.
Phase 2 of the inquiry has examined the broader national picture and considered if procedures and practices in other hospital and non-hospital settings, where deceased people are kept, safeguard their security and dignity.
During his time as a maintenance worker, he also abused the corpses of at least 101 women and girls at Kent and Sussex Hospital and the Tunbridge Wells Hospital before his arrest in December 2020.
His victims ranged in age from nine to 100.
Phase 1 of the inquiry found he entered one mortuary 444 times in the space of one year “unnoticed and unchecked” and that deceased people were also left out of fridges and overnight during working hours.
‘Inadequate management, governance and processes’
Presenting the findings on Tuesday, Sir Jonathan Michael, chair of the inquiry, said: “This is the first time that the security and dignity of people after death has been reviewed so comprehensively.
“Inadequate management, governance and processes helped create the environment in which David Fuller was able to offend for so long.”
He said that these “weaknesses” are not confined to where Fuller operated, adding that he found examples from “across the country”.
“I have asked myself whether there could be a recurrence of the appalling crimes committed by David Fuller. – I have concluded that yes, it is entirely possible that such offences could be repeated, particularly in those sectors that lack any form of statutory regulation.”
Sir Jonathan called for a statutory regulation to “protect the security and dignity of people after death”.
After an initial glance, his interim report already called for urgent regulation to safeguard the “security and dignity of the deceased”.
On publication of his final report he describes regulation and oversight of care as “ineffective, and in significant areas completely lacking”.
David Fuller was an electrician who committed sexual offences against at least 100 deceased women and girls in the mortuaries of the Kent and Sussex Hospital and the Tunbridge Wells Hospital. His victims ranged in age from nine to 100.
This first phase of the inquiry found Fuller entered the mortuary 444 times in a single year, “unnoticed and unchecked”.
It was highly critical of the systems in place that allowed this to happen.
His shocking discovery, looking at the broader industry – be it other NHS Trusts or the 4,500 funeral directors in England – is that it could easily have happened elsewhere.
The conditions described suggest someone like Fuller could get away with it again.