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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.

Can we mend the NHS? Watch a special programme at 1800 with Mark Austin on Sky News


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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‘Heroic’ rail worker who tried to stop train knife attacker still in life-threatening condition

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'Heroic' rail worker who tried to stop train knife attacker still in life-threatening condition

A “heroic” rail worker who tried to stop a knife attacker as he carried out a mass stabbing on a high-speed train remains in a life-threatening condition.

A 32-year-old man who was arrested after the 6.25pm Doncaster to London King’s Cross LNER service on Saturday was stopped at Huntingdon, Cambridgeshire, is being treated as the only suspect, police said.

The man who is from Peterborough, where he boarded the train, is being held in custody on suspicion of attempted murder, while another man, 35, who was also arrested has been released with no further action.

Train stabbing latest: Two victims still fighting for lives

A knife was recovered at the scene after armed police were deployed to the train and made the arrests within eight minutes of the 999 call.

In total, 11 people were treated in hospital – nine were initially reported as having life-threatening injuries.

One of the two men arrested at Huntingdon Station by police
Image:
One of the two men arrested at Huntingdon Station by police

Five casualties have now been discharged and one – a member of LNER rail staff who tried to stop the attacker – remains in a life-threatening condition, British Transport Police (BTP) said in a statement on Sunday evening.

BTP Deputy Chief Constable Stuart Cundy said: “This was a horrific attack that has had a wide impact.

“My thoughts and those of everyone in British Transport Police are with those injured and their families – especially the brave member of rail staff whose family are being supported by specialist officers.

“Having viewed the CCTV from the train, the actions of the member of rail staff were nothing short of heroic and undoubtedly saved people’s lives.”

The train driver hailed as “courageous” for his actions during the stabbings has been named as Andrew Johnson.

“The driver did everything he was trained to do, at the right time and in the right way,” said Nigel Roebuck, full-time organiser in the north-east of England for the train drivers’ union Aslef.

“He brought the train into a station where passengers could disembark safely and where police, fire and rescue, and ambulance crew could get on to the train and attend to the victims and, we believe, catch the culprit.

“He showed real courage, real dedication, and real determination in the most difficult of circumstances.”

Emergency responders at Huntingdon station in Cambridgeshire on Saturday night. Pic: PA
Image:
Emergency responders at Huntingdon station in Cambridgeshire on Saturday night. Pic: PA

Police earlier said the two men arrested included a 32-year-old male, a black British national, and a 35-year-old man, a British national of Caribbean descent. Both were born in the UK.

In an update, they said the 35-year-old, who is from London, was not involved.

A witness told Sky News that police fired a Taser at a man with a large knife, after he went on a bloody rampage on the high-speed train.

In a statement, the King and Queen said they were “truly appalled and shocked to hear of the dreadful knife attack,” and offered their “deepest sympathy and thoughts” to those affected.

Emergency crews spilled out onto the tracks. Pic: PA
Image:
Emergency crews spilled out onto the tracks. Pic: PA

Police erected a cordon outside the station. Pic: PA
Image:
Police erected a cordon outside the station. Pic: PA

Police examine ‘motivations’ for attack

Counter-terrorism police were initially supporting the investigation.

But BTP Superintendent John Loveless said there was “nothing to suggest that this is a terrorist incident”, adding that the investigation would continue to examine the “motivations” which led to the attack.

Investigators examine the scene outside Huntingdon station. Pic: PA
Image:
Investigators examine the scene outside Huntingdon station. Pic: PA

Pic: PA
Image:
Pic: PA

BTP Dep Chief Con Cundy said: “Our investigation is moving at pace and we are confident we are not looking for anyone else in connection to the incident.

“As would be expected, specialist detectives are looking into the background of the suspect we have in custody and the events that led up to the attack.”

Witnesses told Sky News the stabbings started a few minutes after the train left Peterborough and passengers sounded the emergency alarm.

People described how some passengers were trampling over each other and hiding in the toilets to escape the attacker.

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Policing commentator Graham Wettone speaks to Gillian Joseph

Prime Minister Sir Keir Starmer said it was an “appalling incident” and was “deeply concerning”.

“My thoughts are with all those affected, and my thanks go to the emergency services for their response,” he wrote on X.

Armed police, paramedics, air ambulances, and transport police arrived within minutes. Pic: PA
Image:
Armed police, paramedics, air ambulances, and transport police arrived within minutes. Pic: PA

Officers wearing forensic suits with a police dog outside the station. Pic: PA
Image:
Officers wearing forensic suits with a police dog outside the station. Pic: PA

‘Extraordinary bravery’

The main opposition leaders, Kemi Badenoch and Ed Davey, have also reacted.

The Tory leader initially said she was “deeply disturbed” by events. Later, she posted an update online suggesting “there’s clearly something going wrong in our society right now”.

The Lib Dem leader took a different approach in his statement, focusing on the “very best of Britain” and the “extraordinary bravery” of those at the scene.

Route of the LNER train service from Doncaster to London King's Cross
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Route of the LNER train service from Doncaster to London King’s Cross

‘Shocked and frightened’ passengers

Defence Secretary John Healey spoke to Sky News on Sunday Morning with Trevor Phillips and said he took the same train route just hours before the attack.

“It’s the service I use every week to get home to Rotherham, so I can’t begin to imagine how shocked and frightened those passengers were.”

Asked by Phillips if the attack has changed the UK’s terror threat level, he said no and that it remains “substantial” – meaning an attack is considered “likely”.

Read more:
‘They’ve got a knife’: Eyewitness recalls attack
How the attack unfolded

Watch: Moment armed police arrive at train stabbing

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Why stabbing ‘close to home’ for Defence Secretary

‘Like a horror film’

Mayor of Huntingdon, councillor Audrey McAdam, told Sky News she was “very emotional” after hearing about the stabbing and said it must have been like a “horror film” for the passengers.

“I’m still in shock… I’m very emotional, and as soon as I found out, I thought, ‘oh no’.

“I’m worried about the people actually in hospital at this moment… it’s something I never thought would ever happen around Huntingdon… it’s something so dreadful.

“But to live in that moment… it’s a horror film… complete horror. I just cannot imagine what the people must have [been] feeling… When you’re stuck on a train, what can you do? A moving train.”

Huntingdon's mayor told Sky News it must have been like a 'horror film' for passengers
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Huntingdon’s mayor told Sky News it must have been like a ‘horror film’ for passengers

An ‘incredible’ response from emergency services

Huntingdon MP Ben Obese-Jecty spoke to Sky News at the scene on Saturday night. He said: “When I first arrived here, I’ve simply never seen as big a response to an emergency incident as there was in terms of police, fire and ambulance.”

On Sunday morning, Mr Obese-Jecty spoke again about the “rapid, incredible response” and praised the “brave officers who came to try and neutralise that threat”.

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Police prepared for marauding attack a week ago

Extra police are reportedly going to be deployed across the rail network for at least the next few days.

Government sources have told the PA news agency that there will be a “surge” in the police presence, lasting until Tuesday at least.

Officers are likely to focus on major terminals such as London, Birmingham, York, Leeds and Manchester, as well as at Huntingdon.

National Rail said some train routes to and from London King’s Cross on LNER, Great Northern and Thameslink services faced disruption on Sunday.

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Police rehearsed a knife attack scenario on a train line in March – here’s what went differently this time

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Police rehearsed a knife attack scenario on a train line in March - here's what went differently this time

British Transport Police held an emergency exercise for press officers in March, which ironically involved a stabbing on a train travelling south near Huntingdon.

In the training drill, the train stopped immediately between stations when a passenger pulled the emergency cord.

It took police 25 minutes to reach the train and casualties, far longer than the eight minutes in which Cambridgeshire firearms officers reached the scene at Huntingdon station.

Follow latest: ‘Nothing to suggest’ terror attack, police say

Chris Webb, a crisis communications expert who helped run the exercise, said: “People think if you pull the emergency cord on a train it stops immediately, but that’s not what happens these days.

“As soon as the driver knows there is a problem, he or she radios the line operator HQ and they discuss where to stop.

“The decision last night was to keep going to Huntingdon station, where it was much easier for armed police to get on.”

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Forensic investigators at Huntingdon train station in Cambridgeshire
Image:
Forensic investigators at Huntingdon train station in Cambridgeshire

He added: “It must have been awful for passengers when the train kept going for another ten minutes or so.

“It’s always a balance. It might have prolonged the attack, but stopping in the middle of nowhere can mean the attack stops but it’s much more difficult for the emergency services to get there.”

Mr Webb, former head of news at Scotland Yard, said such exercises are held regularly by train operators.

A similar drill was carried out on the London Underground weeks before the 7/7 bombings in 2005.

“There are always lessons to learn but you cannot guard against everything.”

In the training exercise in March the suspect was a white man with mental health issues. He was shot dead by police.

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‘Two suspects are British nationals’

Read more:
What we know so far about the Huntingdon train stabbings
Eyewitness recalls horror attack on high-speed train

What happened in the Huntingdon attack?

Police triggered the Plato code to all emergency services in their initial response to the Huntingdon train stabbing, but that did not label it a terrorist attack.

Plato is called for a major incident where it’s thought a suspect is on the loose and has already, or is liable to, cause serious injury.

Plato does not denote a terror attack, though it is often used in terrorist incidents.

A forensic investigator on the platform by the train at Huntingdon train station in Cambridgeshire
Image:
A forensic investigator on the platform by the train at Huntingdon train station in Cambridgeshire

In a Plato response paramedics, fire fighters and other first responders are sent to a safe rendezvous point while armed police go in and deal with the suspect.

Plato depicts a situation where unarmed responders are vulnerable and are kept back until it is safe to approach casualties.

There are exceptions and it’s understood the East of England Ambulance Service has a special Hazardous Area Response Team (HART) which was allowed to accompany armed police onto the platform where the two suspects were arrested last night.

Once other first responders were allowed in, Plato was called off – an important part of the operation.

Plato was called during the initial response to the Manchester Arena bomb attack in 2017, but the fire service was not told it had been called off for two hours and that meant its officers did not go in to help with the rescue.

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‘I thought I was going to die’: Passenger tells of panic during knife attack on train

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'I thought I was going to die': Passenger tells of panic during knife attack on train

A student has told how she thought she “was going to die” during a mass stabbing on board a high-speed train.

Amira Ostalski was travelling to London for a Saturday night out with her friend Vanessa on board the “very busy” 6.25pm Doncaster to King’s Cross LNER service.

She told Sky News correspondent Dan Whitehead they were “listening to music, just having a good time”, when “panic and chaos” broke out in her carriage, Coach G, between Peterborough and Huntingdon.

Follow latest: Moment train attack suspect was arrested pictured

“I see five rows ahead of us a guy in a white t-shirt just jumps out of his seat,” she said. “People are screaming, ‘he’s got a knife’…. I’m guessing he stabbed the person right in front of me.”

Ms Ostalski said she came within 2m of the attacker but only caught a glimpse of him adding: “He was just a black bearded guy wearing all black and a hoody.

Woman who saw attack on train at Huntingdon tells Sky News of her experience
Image:
Woman who saw attack on train at Huntingdon tells Sky News of her experience

“I didn’t see the knife he was holding. I’m guessing because it was already in the body or something.”

She said she “started running” and was “trying to calm everyone down” because there was a young boy, around six years old, who hid in the toilets with his mum.

“Everyone’s running. A guy next to me is holding his arm saying he’s been stabbed. He was running. I see people covered in blood,” she said.

“Everyone was shocked, everyone was terrified. People wanted to know what was going on, everyone’s pushing and shoving. Everyone’s getting trampled.”

Woman who saw attack on train at Huntingdon tells Sky News of her experience
Image:
Woman who saw attack on train at Huntingdon tells Sky News of her experience

Ms Ostalski said she heard some people crying on the phone “in tears and in shock, thinking they’re going to be stabbed”.

“It was horrific, it was really horrific because we had no idea where he was and the conductor who tried to stop him, he got stabbed as well.

“We felt that we were not safe because we were trying to get the train to stop but it wasn’t stopping.”

Route of the 6.25pm London North Eastern Railway (LNER) service between Doncaster and London King's Cross
Image:
Route of the 6.25pm London North Eastern Railway (LNER) service between Doncaster and London King’s Cross

Ms Ostalski said she ran into the buffet car where she picked up a metal tray to protect herself and her friend.

“I was honestly so petrified. I thought in that moment it was the last time I was ever going to be alive. I thought I was going to die,” she said.

Read more:
Police rehearsed train knife attack scenario in March
What we know so far

Ms Ostalski said she saw the attacker again when the train was stopped at Huntingdon station by the door, holding a bottle in his left hand.

“He just looked so calm and I think that was the most terrifying thing,” she said.

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Armed officers were seen running along the platform at Huntingdon station towards the train carriages after multiple people were stabbed on board.

Moment of suspect's arrest
Image:
Moment of suspect’s arrest

Police declared a major incident and armed officers can be seen in video footage sprinting along the platform.

Ms Ostalski said she thought she and the other passengers were safe when the train was evacuated.

But when she reached the car park, she turned around and saw the attacker jump the fence and start coming towards them.

“I have to admit, the police came really quickly and managed to detain him,” she said.

“I saw them running then took the knife and he got tasered and fell right on the spot.”

Two men born in Britain have been arrested over the attack, which police do not believe was motivated by terrorism, but Ms Ostalski said she only saw one of them.

A total of 11 people have been treated in hospital for their injuries, while two people remain in a life-threatening condition.

Ms Ostalski said she finally found safety in a taxi but will remember the ordeal for the rest of her life.

“Honestly, I’m scared to sit on a train,” she added.

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