On July 5, 1948, British Health Secretary Aneurin Bevan officially started the NHS, then a unique experiment to provide free universal healthcare upon use.
Seventy-five years of that ambition has largely remained, enshrined in the 2011 NHS Constitution’s guiding principles and public pledges.
But the reality is different, with data revealing access to healthcare is getting worse, inequality is growing, and disparities across the country are stark leaving large portions of the population behind.
Your address, your ethnicity, your gender, and above all, your socioeconomic status are very much linked to how long and healthy your life will be.
Explore your area on the map below:
Zip code lottery – north-south division?
One of the places where the gap between rich and poor is most pronounced is in The Wirral, which is home to Birkenhead, a severely deprived area with one of the lowest life expectancies, and Gayton, an affluent area with above-average health.
Dr Laxman Ariaraj, a general practitioner at Fender Way Health Center who has worked in the Birkenhead area for 20 years, has seen health inequalities widen there over time.
He said: “Certainly access has become more difficult over time, which may expand the broader determinants of health.
“The sheer number of people we need to see will impact the amount of time we can spend doing things proactively.
“On a positive note, I think we’re becoming more aware of that and it’s giving us an opportunity to try and do something about it.”
The government has committed to cutting the NHS waiting list, but across the country little progress has been made. North West, where Birkenhead is located, is the worst affected area with the longest waiting time.
The NHS operational target is that 92% of people should be treated within 18 weeks of being referred by a consultant. However, two-fifths of the 7.4 million waiting lists for treatment are currently waiting longer.
North West has seen the largest increase in waiting in the UK, from 13% in listings over four months in April 2019 (about average compared to other regions), to 46.1% in the latest data for April 2023.
Overall, the waiting list increased by more than three million from 4,315,000 in April 2019. At that time 87% of prospective patients had waited less than 18 weeks.
The situation in the north in general and in the Northwest in particular is more concerning given the health inequalities that already exist here.
There are some extremely disadvantaged neighborhoods with higher rates of deficiency than anywhere else in the country, such as Blackpool, and this plays a large part in poor health outcomes.
However, this does not fully explain the disparity in health with other regions. On any cross section, London tends to have a higher life expectancy, even though the areas share the same socioeconomic status:
There is no definitive explanation for the phenomenon, but Dr Bola Owolabi, a general practitioner in the Midlands and director of Health Inequality in NHS England told Sky News it could be partly explained by communities being more difficult to track in official metrics.
Dr Owolabi said: “We realized that there were other drivers beyond simply using the Index of Multiple Deprivation.
“For example, people who experience homelessness or difficulty sleeping, and migrant communities may not appear in the data.”
Deficient areas have less access to resources
The current NHS crisis and backlog of care affects everyone, but may not affect everyone equally.
Analysis by The Health Foundation has shown a decreased proportion of people admitted to hospital after presentation at A&E due to bed rationing.
The most significant reduction in emergency admissions was seen among people living in the most disadvantaged areas, by 80,000 between 2019 and 2022. This is more than double the 35,000 decrease for those living in the most disadvantaged areas.
While the total number of days a patient spent in hospital increased in most regions, it decreased for patients in the most disadvantaged regions.
Patients in the most disadvantaged areas of the country had 107,000 fewer hospitalization days in 2022 compared to 2019. The net increase in hospital days for emergency hospitalization was 329,000.
The challenge of training and retaining enough doctors and other healthcare staff to cover vacancies has also been a major challenge for the NHS in recent years to meet the needs of a growing and aging population.
But more disadvantaged areas have additional challenges with recruiting.
Sky News analysis has found that local GPs for someone living in one of the UK’s most disadvantaged areas, have an average patient workload of 61% higher than the average local GP for residents in the wealthiest areas of the country.
This gap has increased slightly since 2015, when it was 59%. That is despite government efforts to incentivize trainees to take up positions in underserved areas.
“The pressure on the NHS has the potential to damage the health of the poor.”
The Marmot review of health inequalities, first published in 2010 with a ten-year follow-up in 2020, concludes that inequalities in health and life expectancy result from social problems including employment, housing and shortages.
Professor Sir Michael Marmot, director of The UCL Institute of Health Equity, told Sky News: “I have long said that given the equity of access across the NHS it is highly unlikely that difficulties in access to treatment play a large role in inequalities in health. I may need to modifying that conclusion in light of recent history.
“You get both: that the pressure on the NHS has the potential to undermine the health of the poorer. And that the poor health of the poorer people – because of social and economic inequalities in society – has the potential to become an unbearable burden on the NHS.”
Ethnic based inequality
People from ethnic minority backgrounds tend to be disproportionately affected by deprivation.
Data from the Ministry of Housing, Communities & Local Government shows that ethnic minorities are far more likely to live in the poorest 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 disposable household net income.
According to the latest census data, more than one-fifth of people of Asian background live in overcrowded conditions (having fewer than the required number of bedrooms).
People from black backgrounds are 6 times more likely than white people to live in overcrowded homes.
Access to primary care health services is generally fair for ethnic minority groups.
However, people from ethnic minority groups are more likely to report poorer health and have higher death rates.
Research from the REAL Center of the Health Foundation shows that individuals from South Asian backgrounds, particularly Bangladeshis and Pakistanis, have a higher incidence of diagnosed chronic pain, diabetes, and cardiovascular disease.
The prevalence of diagnosed chronic pain is about three-fifths higher among Bangladeshis and Pakistanis than among whites.
People of black African ethnicity also have a higher prevalence of chronic pain.
Chronic pain among other conditions is also prevalent in disadvantaged environments. The prevalence of diagnosed chronic pain more than doubles in the most disadvantaged settings compared to the most disadvantaged settings.
However, the cancer is more common in people from white backgrounds and nearly twice as high in people from South Asian backgrounds.
Hope to address health inequalities
The National Health Inequality Improvement Program was established in 2021 to address health care inequalities and ensure equitable access to health services and it provides hope for tackling health inequalities.
Programs work to deliver projects and services targeted at people living in the most disadvantaged areas of the UK and others who are less fortunate.
This includes increasing access to digital services and helping people find jobs.
Dr Owolabi said: “The NHS, as commissioners, and service providers, can materially affect health inequalities.”
Many cities have decided to focus broadly on implementing the policy changes envisioned by Marmot in its review.
These cities have been given the name ‘City of Marmots’ and have experienced a significant increase in health inequality.
There may be some early signs of success with this program. Coventry was one of the first cities to adopt the Marmot principle, and since then, Professor Marmot said: “The percentage of five year olds with good development has increased…
“The percentage of people aged 18 to 24 who are unemployed, uneducated or trained is going up. And the proportion of people earning a living wage is also increasing.”
Sky News has contacted the Department of Health and Social Care for comment on our findings.
That Data and Forensics team is a multi-skilled unit dedicated to providing transparent journalism from Sky News. We collect, analyze and visualize data to tell data-driven stories. We combine traditional reporting skills with advanced analysis of satellite imagery, 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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