With just 5% of its health budget invested in prevention, the UK is struggling under the strain of an aging population

The UK is falling behind its international peers in managing chronic health conditions, despite having one of the most advanced and future ready health systems globally, according to Zurich’s latest report, The Value of Chronic Care. Britain’s health service is increasingly overwhelmed by an ageing population and a surge in chronic illness, with new analysis warning the NHS is still structured for short-term treatment rather than long-term care.

Currently, the UK spends just 5% of its health budget on prevention¹, highlighting a significant gap in early intervention. This has contributed to over 2 million people in the UK who are economically inactive due to long-term health conditions² with around 300,000 leaving the workforce annually due to ill health³.

The report finds the UK is now operating in a “chronic reality”, where millions are living longer but spending years managing conditions such as diabetes, heart disease and dementia. Across developed economies one in three adults now lives with a long-standing illness or health problem⁴.

UK middle of the pack as gaps in care drive pressure on hospitals

Despite ranking third in the world for readiness, the UK ranks firmly in the middle of Zurich's Chronic Care Index (22nd) placing it ahead of countries like Germany (24^th) and the US (27^th), but behind France (15^th), Ireland (13^th) and Australia (8^th).⁵ The Index combines the scores for chronic disease burden and health system performance across all 38 countries of the Organisation for Economic Co-operation and Development (OECD). Countries with the lowest burden and strongest systems place highest.

UK rankings among 38 OECD countries

• Chronic Care Index: 22^nd
• Chronic disease burden: 25^th
• Health system performance: 12^th
• Capacity: 15^th
• Quality: 22^nd
• Readiness: 3^rd

The UK has a moderate disease burden (ranking 25^th), but its health system performance is relatively strong (12^th) thanks to its high level of readiness (3^rd). However, this contrasts with weaker quality (22^nd) and capacity (15^th) leading to limited outcomes. In practice, this means patients aren't always seen early enough and conditions are more likely to deteriorate while people are waiting to be seen, leading to increasing pressure on hospitals and emergency care.

System built for acute crises now under chronic pressure

The report highlights a fundamental misalignment at the heart of the UK’s healthcare system; fewer people are dying early but many more are living longer with illness, and more are requiring continuous care rather than one-off treatment. This has led to chronic disease being the dominant driver of demand, placing strain on hospitals, A&E and other acute services.

The pressure on the UK is being compounded by demographic change, with older populations far more likely to live with multiple conditions at once. This leads to more complex cases, longer treatment and repeated admissions to hospital. As the UK’s population ages, the system has to sustain its performance and this intensifies year-on-year.

European countries show a different path

Contrastingly, countries such as the Netherlands are showing how systems can adapt to the same pressures more effectively. The Netherlands ranks second on the Chronic Care Index, despite only mid-level spending and a moderate disease burden (20th). Their health systems focus on strong primary care and coordination, early intervention and preventive support, and lower rates of avoidable hospital admissions, leading to it ranking first globally for health system performance. It has the highest quality score in the OECD (1st) and a high readiness score (1^st), meaning patients benefit from more consistent and integrated care and the country is able to manage chronic conditions before they escalate into emergencies - despite a weaker capacity score (13^th).

Similarly, Switzerland which ranks first in the Chronic Care Index demonstrates that even with an ageing population, strong coordination, trust and continuity of care can prevent worse outcomes over time.

Commenting on the findings, Peter Hamilton, Head of Market Engagement at Zurich UK said:

“The UK is exceptionally good at treating people once they are sick, but chronic disease doesn’t start in hospital – it develops over years and often silently. Countries that perform best focus relentlessly on early detection, prevention and ongoing management. The Netherlands shows that this isn’t about spending but more but about organising care differently.

“The NHS is one of the strongest acute care systems in the world, but that’s not the challenge it’s facing anymore. What we’re seeing now is a system designed for emergencies being asked to manage conditions that last decades. When care isn’t joined up, patients deteriorate – and that inevitably pushes demand into hospitals. The UK needs to manage conditions before they escalate in order to ease pressure on hospitals otherwise acute systems will remain under constant strain.

“Improving chronic care requires not only expansion, but redesign. This means connecting services, improving coordination, and supporting individuals over time. Warning signs are often first visible in the workplace – through absence, reduced performance, or shifts in behavior. This makes workplace systems, employer engagement, and employee benefits a key part of the chronic care response, particularly for conditions that develop and persist over long periods. Supporting people to remain at work, or to return in a structured way, is not only an economic priority, but can be a health outcome in itself – all of which are key themes of the ‘Keep Britain Working’ report.”

About the research

The Value of Chronic Care is based on analysis across all 38 OECD countries from 2014 to 2023 and covers more than 200 chronic conditions. It forms the second part of Zurich’s The Value of Health & Wellbeing series, following The Value of Mental Health, published in April 2026.

• Office of National Statistics. Healthcare expenditure, UK Health Accounts: 2023 and 2024 (2025)
• Gov.UK. Keep Britain Working: Final report (2026)
• The Health Foundation. Towards a healthier workforce (2024)
• OECD. Health at a Glance 2025: OECD indicators (2025)
• Zurich's Chronic Care Index 2026

Scores: Chronic Care Index (0–100)