Angie currently lives in the English Midlands but is preparing to move to Bulgaria. She has suffered for years from multiple chronic health issues including ME and an autoimmune thyroid condition. She says holidaying in Bulgaria has been transformative – enough that she has decided to leave the UK.
A Department of Health and Social Care spokesperson told the BBC it is shifting the focus of healthcare from sickness to prevention. “We are committed to reducing health inequalities, GP patient satisfaction is up, and waiting lists are down by 340,000 compared to July 2024,” they said.
So what is driving the UK’s fall in healthy life expectancy? And why is a nation with a system specifically designed to give everyone equally good care lagging behind others?
What’s the alternative?
The UK is facing similar issues to many of its peers; an ageing population, cost of living pressures and a growing burden of mental health problems.
But while citizens of many other countries report improvements to their health, those in the UK say it is getting worse. Health Foundation analysis of ONS figures shows the share of adults rating their health as “good” or “very good” dropped from 76% in late 2020 to around 71% in late 2025, a decline of 5%. Meanwhile in countries such as Bulgaria and the Netherlands the proportion of people reporting good health has risen.
Gareth Lyon, head of health and social care at right-leaning think tank Policy Exchange, argues the UK’s decline can partly be laid at the door of its “creaking” National Health Service. “The UK is becoming an outlier… we’re not prepared to look at how we make our system sustainable for patients in the long run,” he says.
He points to Health Foundation figures suggesting access to GP appointments and early medical intervention lag behind the Netherlands, with half of Britons reporting they “always or often” receive a same-day response from their GP, compared to eight out of 10 Dutch people.
Meanwhile, one in five British patients wait over a year for non-urgent surgery; in the Netherlands the figure is zero.
Lyon blames this on the UK healthcare model in which the state both funds and provides treatment; this lack of competition means there is little motivation for contract holders to become more efficient, save costs or respond quickly to patient concerns, he says. Although patients in the UK can opt to go private if they can afford it.
Instead, he argues the UK should largely replicate the Dutch healthcare system, in which adults pay for compulsory health insurance, with subsidies offered to those on low incomes, which he says has created a highly competitive environment among insurers and healthcare providers, incentivising the best treatment for patients.
Since this model was adopted 20 years ago, Lyon says the Dutch have seen a “massive expansion of primary care, early diagnosis and treatment” while still offering universal healthcare.
For Rees, this is the heart of the UK’s problem, and helps explain why countries can offer universal, free health services and still fall behind. Different parts of the UK show a stark disparity for health life expectancy: a woman in Richmond‑upon‑Thames can expect to enjoy a healthy life two decades longer than one in Hartlepool.
Prof Martin McKee from the London School of Hygiene and Tropical Medicine has spent his career comparing different countries’ healthcare systems.
He argues the NHS has suffered from years of underinvestment since austerity policies were introduced. “The UK has constantly been scrimping and saving… we are low on scanners, low on Like Rees, he suggests the roots of the UK’s healthy life expectancy lies in poverty and lack of opportunity.
Around one in four adults aged 16 to 29 years were experiencing moderate to severe depressive symptoms in April last year, the ONS says, while across the UK, those in the poorest fifth of the population are twice as likely to be at risk of developing mental health problems as those on an average income.
Much of the UK’s decline in healthy life expectancy is concentrated among marginalised groups, who are more likely to live in Scotland and the North of England, McKee points out.
It is no coincidence that these areas also contain the hotspots for “deaths of despair” – deaths resulting from drugs, alcohol and suicide. Many of the factors behind these deaths of despair, including addiction, poor diet and stress, also contribute to people spending more of their lives in ill health.
The 15-minute GP appointment
Some doctors are testing new approaches, seeing if tweaking the way NHS works can deliver better health. Dr David Blane is a GP in Glasgow’s Possilpark, and academic lead for GPs at the Deep End, an organisation led by doctors in Scotland’s most deprived communities.
He says patients in these neighbourhoods typically develop multiple long‑term conditions 10 to 15 years earlier than those in wealthier areas.
“Not only is there a good chance that you’ve got more long‑term health problems, but there’s also other things going on in your life impacting on your mental health – lots of low mood, depression, chronic pain… These things have a big impact on your quality of life, your sense of self, your sense of purpose.”
Part of GPs at the Deep End’s role is to pilot new strategies to try to reduce healthcare inequalities.
One strategy has been to extend all appointments to 15 minutes. “That certainly helps with empathy. It helps with managing potentially more than one problem in a consultation and GP stress as well,” Blane says.
