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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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‘I don’t remember feeling this unsafe’: Frightened worshippers too scared to walk the streets

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'I don't remember feeling this unsafe': Frightened worshippers too scared to walk the streets

“I don’t remember feeling this unsafe ever before,” says 76-year-old devout Sikh Resham Kaur who moved to the UK from India when she was 18.

She’s waiting for two men to walk her home from the gurdwara – a Sikh place of worship – at a time of rising fears over physical and verbal racial abuse.

Resham reaches for her walking stick and puts on her shoes.

Sarbjit Singh and Mangat Singh walking Resham Kaur home from the gurdwara
Image:
Sarbjit Singh and Mangat Singh walking Resham Kaur home from the gurdwara

Monty Singh says they are 'not vigilantes'
Image:
Monty Singh says they are ‘not vigilantes’

“When I came to this country, I didn’t fear for my safety. But now I do – every day. It’s a lot worse now,” she says.

It’s a disturbing admission at a time when some fear Britain’s communities are more fragmented than ever.

It comes as new figures last week revealed religious hate crime recorded by police in England and Wales has reached a record high.

Two volunteers arrive, opening the exit door for Resham at the gurdwara in Smethwick in the West Midlands.

Sarbjit Singh – who works in a bakery – and Mangat Singh – who works at a salad farm – are part of the congregation and walk people to and from the gurdwara on their days off to keep them safe.

With attendance numbers at the gurdwara falling because of safety fears, Sarbjit says it’s something they need to do “until we get a bit of peace and tranquillity back in society and the community”.

“We have to do something. We can’t just sit in silence. And we can’t let the congregation just stay at home,” Sarbjit says.

The Oldbury patrol
Image:
The Oldbury patrol

Other groups of Sikh men are also taking action – joining patrols along a road in nearby Oldbury where a young Sikh woman was allegedly raped a few weeks ago.

That alleged attack – and an assault on two taxi drivers in Wolverhampton in August – have horrified the Sikh community. Police are treating both incidents as racially aggravated.

Two Sikh taxi drivers were allegedly assaulted in Wolverhampton in August
Image:
Two Sikh taxi drivers were allegedly assaulted in Wolverhampton in August

Monty Singh, who is taking part in the patrols, says they are “not vigilantes”.

“We need to make it crystal clear that we’re good people, we’re just trying to do the right thing and support our community,” Monty adds.

Pervinder Kaur is the vice president of the gurdwara.

Pervinder Kaur said before the summer people felt safe, but racial abuse is being emboldened
Image:
Pervinder Kaur said before the summer people felt safe, but racial abuse is being emboldened

She believes racial abuse is being emboldened after a summer of demonstrations outside hotels housing asylum seekers and renewed debate about immigration.

“People are more verbal about it now. They are not scared of the consequences,” she said.

A sense of vulnerability is common among minority communities and security measures have also been stepped up at mosques around the country.

Iman Adam Kantar said 'the Union Jack is our flag'
Image:
Iman Adam Kantar said ‘the Union Jack is our flag’

Friday prayers at the Rumi Mosque in Edmonton, north London
Image:
Friday prayers at the Rumi Mosque in Edmonton, north London

Imam Adam Kantar from the Rumi Mosque in Edmonton, north London, said: “Many people are now telling their children not to be outside after certain hours.

“Their [husbands], they prefer to go shopping instead of their hijab [wearing] wives and spouses.

“We have to engage with the wider community and prove that we love this country and its people. The Union Jack is our flag.”

What Britain’s fragmented society has in common is fear among minority communities – even if the causes are different.

Rabbi Josh Levy, the co-lead of Progressive Judaism, has spent years trying to advance interfaith dialogue.

He said: “Single individual(s) or small groups can cause a huge amount of pain and distress.

“There are lots of really great examples of community cohesion around the country. But generally, there is definitely a sense of fragmentation. And whether it’s driven by political concerns or what’s happening internationally.

“We’ve got huge work to do in taking the work that happens on a national level and bringing it into local communities.”

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‘Make or break’: Chancellor warned businesses can’t take more tax hikes in budget

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'Make or break': Chancellor warned businesses can't take more tax hikes in budget

Rachel Reeves has been warned that firms face a “make-or-break moment” at next month’s budget.

The British Chamber of Commerce (BCC) urged the chancellor, who is widely expected to announce tax hikes in November’s budget to fill a gap in the public finances, to steer clear of increasing levies on businesses.

Ms Reeves raised taxes by £40bn last year and the BCC said business confidence had not recovered since.

“Last year’s budget took the wind from their sails, and they have been struggling to find momentum ever since,” BCC director-general Shevaun Haviland said.

She said firms felt “drained” and could not plan ahead as they expected “further tax demands to be laid at their feet” when the budget is delivered on 26 November.

“The chancellor must seize this moment and use her budget to deliver a pro-growth agenda that can restore optimism and belief amongst business leaders,” Ms Haviland added.

“This year’s budget will be a make-or-break moment for many firms.”

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The BCC also called for a reform of business rates and the removal of the windfall tax on gas and oil introduced by the last government.

In its submission, the industry body outlined more than 60 recommendations, including the proposal of further infrastructure investment, cuts to customs barriers and action on skill shortages.

Earlier this year, Prime Minister Sir Keir Starmer announced Labour would aim to approve 150 major infrastructure projects by the next election, with Labour already pledging to support expansions of both Heathrow and Gatwick airports – another of the BCC’s requests.

While the Treasury would not comment on budget speculation, a spokesperson insisted Ms Reeves would “strike the right balance” between ensuring funding for public services and securing economic growth.

She has vowed to stick to Labour’s manifesto pledges not to raise taxes on “working people”.

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Household spending on the wane

The BCC’s plea to halt further tax rises on businesses comes as retail sales growth slowed in September.

“With the budget looming large, and households facing higher bills, retail spending rose more slowly than in recent months,” Helen Dickinson, chief executive of the British Retail Consortium (BRC), said.

“Rising inflation and a potentially taxing budget is weighing on the minds of many households planning their Christmas spending.”

Total retail sales in the UK increased by 2.3% year-on-year in September, against growth of 2% in September 2024 and above the 12-month average growth of 2.1%, according to BRC and KPMG data.

While food sales were up by 4.3% year-on-year, this was largely driven by inflation rather than volume growth.

Non-food sales growth slowed to 0.7% against the growth of 1.7% last September, making it below the 12-month average growth of 0.9%.

Total retail sales in the UK increased in September compared to the year before. File pic: PA
Image:
Total retail sales in the UK increased in September compared to the year before. File pic: PA

Read more:
Goldman chief delivers warning to Reeves over tax hikes
Reeves urged to break election pledge and raise major tax

Online non-food sales only increased by 1% against last September’s growth of 3.4%, which was below the 12-month average growth of 1.8%.

“The future of many large anchor stores and thousands of jobs remains in jeopardy while the Treasury keeps the risk of a new business rates surtax on the table,” Ms Dickinson said.

“By exempting these shops when the budget announcements are made, the chancellor can reduce the inflationary pressures hammering businesses and households alike.”

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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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