More or Less — The Stats of the Nation: Health

BBC Radio 4 | Host: Tim Harford | Date: January 6, 2026

Episode Overview

This special episode of More or Less delves into the state of health in the UK using statistics to unpick recent trends, challenges, and the future outlook. Host Tim Harford explores the nation's health with actuary Stuart McDonald, health data experts, and economists. Topics include life expectancy, NHS pressures, GP numbers, cancer outcomes, and healthcare productivity.

Key Discussion Points & Insights

1. Life Expectancy: Trends and Concerns

Guest: Stuart McDonald (Actuary)

• Historic Improvements and Recent Stalls

  • Life expectancy increased rapidly in the 1990s and early 2000s, mainly due to better cardiovascular survival.
  • “Life expectancy was increasing by around 15 minutes an hour. So over the course of this show, you’d get seven or eight minutes back…” — Stuart [02:57]
  • Some slowing after 2010, but the real halt came with COVID-19 (2020). As of 2024, averages are nearly back to pre-pandemic levels.
    • 2019: 79.5 years (men), 83.2 years (women). [03:57]
  • Early data for 2025 show record-low mortality, potentially the highest life expectancy ever. [04:38]

• Underlying Worrying Trends

  • “For the over 65s, the news is good. Mortality has recovered post-pandemic and life expectancy is improving.” — Tim [05:47]
  • Death rates rising for younger working-age groups (20–45), even before the pandemic.
    • Causes: accidents, overdoses, suicides in younger ages; chronic disease moves up with age. [06:01–06:49]
  • Issues traced to disrupted preventative care and ongoing NHS challenges post-COVID. [06:49]

• Geographical Differences

  • Scotland lags significantly behind England, Wales, NI: “…life expectancy in England and Wales at the worst moment of the pandemic was still better than at its best ever level in Scotland.” — Tim [08:04]
  • “The effect of living in Scotland essentially is worse than the effect of the pandemic…” — Stuart [08:15]

2. The NHS: Pressures, Performance, and Aging Population

Focus: Metrics that illustrate service strain

• Emergency Services:

  • Ambulance response times (focus on category 2 — heart attacks, strokes):
    • Pre-pandemic target: 18 minutes; often 20 min pre-2020
    • Pandemic peak: 90 minutes (Dec 2022) [09:50]
    • Current (late 2024): 40–50 minutes, rising into winter [10:00]
  • “Before the COVID-19 pandemic, almost no one was waiting more than 12 hours in A&E… [now] more than 50,000 people waiting more than 12 hours in AE in a month.” — Stuart [10:22]

• Systemic Bottlenecks:

  • Delays in moving patients between ambulance, A&E, and wards due to full beds [11:13]
  • Rising demand partly because the population is aging (the “pig in a python” analogy for the baby boomers moving through the system).
  • “The amount of health care that people need increases broadly exponentially with age…” — Stuart [11:50]

• Healthcare Utilization and Costs:

  • “Healthcare costs have been rising more sharply than GDP growth for the last couple of decades.” — Stuart [12:15]
    • Projected NHS spend to rise from 8% to ~9.6% of GDP over a decade (~£50bn increase)
    • Maintaining flat health spending would require big productivity jumps and less inequality.

3. Primary Care and GPs: Promised Growth vs. Reality

Contributor: Nathan Gower

• GP Numbers and Appointments (England):

  • Boris Johnson’s government pledged 6,000 more GPs (2019–2024), but numbers fell by 500 (to below 28,000 fully qualified GPs).
    • Population grew, so GPs-per-patient ratio fell from 52 to 45 per 100,000 (2015–2025). [15:46]
  • “The number of GPS actually fell by about 500 over that period.” — Nathan [15:33]
  • 13.5 million monthly GP appointments in 2024 (up from 13 million pre-pandemic).
  • Across all primary care staff: 30 million appointments/month up from 26 million in 2019. [17:13–17:40]

• Other UK Nations:

  • Wales: GP numbers and ratios flat (48 per 100,000)
  • Scotland: Small recent increase but still below a decade ago.
  • NI: Headcount up 25% since 2014; FTE increase likely smaller.

• Funding:

  • Primary care’s share of NHS England budget: dropped below 9% in 2021–22, recently back up to 10%. [17:46]

4. Cancer Care: Outcomes, International Comparisons, and NHS Delays

Contributor: John Shelton (Cancer Research UK)

• Incidence Rising:

  • Driven by aging population; 360,000 new cases/year, projected to 500,000 in 15 years. [18:56]
  • Age-standardised risk per person now levelling off/slightly reducing thanks to less smoking.
    • “The overall picture is starting to kind of flatten out and slightly reduce for all cancers combined.” — John [19:42]

• Survival Trends:

  • Overall, survival is improving (not equally for all cancers).

  • 10-year survival up for leukemia, kidney cancer; flattened for breast, prostate.

  • UK lags similarly developed nations, primarily due to:

    • Later diagnosis
    • Delays in starting treatment
    • “We diagnose cancers at a later stage in this country and therefore delays in people being diagnosed is a real challenge..." — John [21:26]

  • NHS targets for time-to-treatment (62 days after urgent referral): Not met in any UK nation.

    • Northern Ireland: Only 33% of patients within target (vs. 95% target). [21:54]

5. NHS Productivity: What Is It and Can It Save the System?

Guest: Ben Zaranko (Institute for Fiscal Studies)

• What Is Productivity in Healthcare?

  • “Productivity is the amount of health care services … for the amount of stuff that we put in, most notably staffing…” — Ben [23:42]

• Historical Trends:

  • 1997–2009: Slow growth under rising budgets (New Labour years).
  • 2010–2019: Faster productivity growth during austerity.
    • Average: just under 1% annual growth (1997–2019)
  • Pandemic: 2020 productivity down 24%. As of 2024, still 8% below pre-pandemic levels (ONS and NHS data agree). [25:16–26:12]
  • “In 2024 we were about 8% below where we were pre-pandemic.” — Ben [26:11]

• Can Productivity Alone Solve NHS Funding?

  • Health spending as % GDP set to rise by 7% pts over 50 years (baseline scenario).
  • Even if NHS matched productivity of other sectors, costs would still outpace rest of economy (but could be ~3% GDP savings, or £100bn/year).
    • “…even in an optimistic scenario, we’re probably going to have to spend more on healthcare and we should start planning on that basis…” — Ben [28:39]

Notable Quotes & Memorable Moments

• The accelerating increase in life expectancy, now stalled:
  “Life expectancy was increasing by around 15 minutes an hour...” — Stuart McDonald [02:57]

• COVID vs. health inequality:
  “Life expectancy in England and Wales at the worst moment of the pandemic was still better than at its best ever level in Scotland.” — Tim Harford [08:04]

• ASMR Joke (Actuarial-Style):
  “I’ve always found ASMR very interesting.” — Stuart McDonald
  "Ah yes, asmr. I always wanted a recorder and more or less like that, I find it very soothing myself." — Tim
  “Sorry Tim, I meant Age Standardised Mortality Rates.” — Stuart [13:16–13:27]

• On NHS Outputs vs. Inputs:
  “…what do we get in return in terms of health services that we want for what we are putting into the health service.” — Ben Zaranko [24:13]

• Funding challenge:
  “…even in an optimistic scenario, we’re probably going to have to spend more on healthcare and we should start planning on that basis…” — Ben Zaranko [28:39]

Timestamps for Key Segments

• Life expectancy trends and data: 01:18 – 08:25
• NHS emergency care and bottlenecks: 09:00 – 12:15
• Primary care (GP workforce/funding): 14:46 – 18:10
• Cancer trends and NHS delays: 18:10 – 21:54
• NHS productivity: History, prospects, dilemmas: 21:54 – 29:38

Final Takeaways

• Statistically, the UK’s health story is mixed: good overall life expectancy news masks deep challenges for working-age people and regional inequalities.
• The NHS faces system-wide pressures: surging demand from aging, bottlenecks in urgent care, GP supply issues, and flatlining productivity.
• Major improvements in survival for some cancers, but consistently late diagnosis and treatment set the UK behind.
• Future NHS sustainability hinges on difficult trade-offs: ever-rising spend, big productivity gains, or new ways of delivering care.

For a fact-based, nuanced look at the numbers behind the headlines on UK health, this episode of More or Less is essential listening.