The UK Flare Up Index: Where Environment and NHS Waits Collide

New research from us at The Independent Pharmacy combines a UK-wide environmental index with five years of NHS data, obtained via Freedom of Information (FOI) requests, to show where flare-prone skin and dermatology waiting times are putting patients under the most pressure.

Skin Health Under Pressure

Millions of people across the UK live with flare-prone skin conditions such as eczema, psoriasis and rosacea, conditions shaped as much by environment as by genetics. Hard water, pollen, air pollution and heat can all trigger a flare-up, and where someone lives plays a real part in how often that happens.

At the same time, access to specialist help when a flare-up needs more than home care varies widely depending on where you live. Therefore, we combined a UK-wide environmental index covering 50 cities with five years of Freedom of Information data from NHS trusts and health boards to build the fullest picture yet of where skin health pressure is concentrated and where the two problems compound.

This isn't a story about who has difficult skin. It's a story about geography, about which cities load the dice with hard water and heavy pollen counts, and which NHS trusts have been left carrying years of sustained demand with waiting lists that show no sign of shortening.

Which UK Cities Could Be Toughest on Flare-prone Skin?

This dataset scores 50 UK cities across six environmental factors linked to flare-prone skin: average annual temperature, water hardness, air pollution, grass pollen, tree pollen and pharmacy access. Each factor is weighted equally and scored from 0 to 100, with higher scores indicating worse conditions overall.

Bath tops the ranking with a score of 78.1, driven not by a single extreme reading but by consistently poor scores across nearly every factor. It has the second-highest tree pollen count of any city assessed, some of the hardest water in the country, a high grass pollen count, and just 27 registered pharmacies, one of the weakest pharmacy access scores nationally. Canterbury (75.6), Cambridge (74.6) and Ely (74.2) follow closely behind, each driven by a different combination of the same underlying factors.

Hard water and pollen are doing the most damage further down the table, too. Kingston-upon-Hull recorded the hardest water of any city assessed, at 369.18mg/L, while Cambridge and London recorded the highest grass and tree pollen counts, respectively. Manchester's air was the most polluted of any city in the index, and Ely had the fewest pharmacies of any city assessed, with just 10.

The cities at the other end of the scale

At the opposite end of the table, Scotland's cities cluster together without exception. Glasgow, Stirling, Perth, Aberdeen, Inverness, Edinburgh and Dundee occupy the bottom seven places in the index, a pattern largely driven by cooler average temperatures, softer water and lower pollen counts than in the rest of the UK. It's a reminder that flare-prone skin isn't just about genetics or lifestyle; where someone lives can meaningfully shift how often their skin reacts.

Where is NHS Dermatology Care Under the Most Sustained Pressure?

Freedom of Information requests to NHS trusts and health boards across the UK reveal where dermatology waiting times have stayed under pressure for years, not just in a single bad year. This index averages three measures: median waiting time, patients waiting more than 18 weeks, and patients waiting more than 52 weeks, across the five financial years from 2020/21 to 2024/25. Only the 22 organisations with complete figures for all three measures in every year are included, and because the period starts in 2020/21, it captures years affected by pandemic disruption as well as more recent pressure.

Belfast Health and Social Care Trust tops the index by a wide margin, with a score of 49.1, driven overwhelmingly by long-term waits rather than a single bad year. It averaged 6,210.6 patients waiting more than a year for dermatology care over the five years, more than five times the next-highest trust. Barking, Havering and Redbridge University Hospitals NHS Trust follows in second (41.4), where the pressure shows up differently: it averaged more than 10,700 patients waiting over 18 weeks every year, over three times any other trust in the dataset, despite a comparatively modest median wait of 11.8 weeks. University Hospitals Bristol NHS Foundation Trust ranks third (37.0), driven by the longest average median wait of any trust assessed, at 46.8 weeks.

Dermatology pressure doesn't always look the same from trust to trust. Some, like Belfast, are defined by a smaller number of patients waiting extremely long periods. Others, like Barking, Havering and Redbridge, are managing a much larger volume of patients stuck just past the 18-week mark. Both represent sustained strain, just distributed differently across the waiting list.

Has dermatology pressure grown over the past five years?

The five-year window also shows the direction of travel. Across the 22 trusts and health boards in the dataset, the total number of patients waiting more than 18 weeks for dermatology care rose from 19,821 in 2020/21 to 41,074 in 2024/25, more than doubling. Patients waiting more than a year followed a similar pattern, climbing from 6,744 to 10,466 over the same period. Some of this reflects pandemic-era disruption in the earlier years, but pressure has not eased back down to where it started; 2024/25 still sits more than double the 2020/21 total.

Where the Two Pressures Collide

A handful of places show up under pressure on both fronts. London, Derby, Lincoln and Colchester all rank among the more pressured areas on the five-year dermatology index and sit in the more environmentally pressured half of the flare-up index. London is the clearest example, with Barking, Havering and Redbridge University Hospitals NHS Trust ranking second overall and Great Ormond Street also among the more pressured organisations. Two further London trusts, St George's and King's College, appear in the dataset but sit closer to the middle and lower end of the table.

It's worth being upfront that this is a rough match rather than an exact one. NHS trusts cover whole catchment areas rather than single cities, so we've matched each to its closest city in the flare-up index ourselves. Treat it as a pattern worth flagging rather than a firm ranking.

Speaking on the study, Dr Donald Grant, GP and Senior Clinical Advisor here at The Independent Pharmacy, said:

“What this data shows is that flare-prone skin conditions like eczema, psoriasis and rosacea are shaped by far more than genetics. Hard water, pollen, pollution and heat can all disrupt the skin's natural barrier, and where you live has a real bearing on how often that happens. Using a fragrance-free moisturiser daily, even when skin looks fine, and switching to lukewarm rather than hot water in hard-water areas can both noticeably reduce the frequency of flare-ups.

“What concerns me more is what happens once a flare-up does need specialist input. In areas like Belfast, patients waiting more than a year for dermatology care isn't a rare exception; it's become the sustained reality for thousands of people, year after year.

“A pharmacist is usually a good first port of call for a mild flare-up, and can often help without a referral at all. But for the patients whose conditions genuinely need specialist assessment, a five-year pattern of waits this long isn't something individual advice can fix. It points to a system that needs far more capacity in dermatology services, not just better self-management while people wait.”

Find out more about treatment options for eczema and dermatitis, psoriasis and rosacea here at The Independent Pharmacy.

Methodology

The UK Skin Flare-Up Index scores 50 UK cities across six equally weighted factors: average annual temperature, water hardness, air pollution, grass pollen, tree pollen, and pharmacy access, each normalised to a score from 0 to 100, with higher scores indicating worse conditions for flare-prone skin. Only cities with complete data across all six factors are included; for pharmacy access, a higher score reflects fewer registered premises rather than a poorer environmental reading.

The Dermatology Pressure Index draws on Freedom of Information requests to NHS trusts and health boards, covering three equally weighted metrics: median waiting time, patients waiting more than 18 weeks, and patients waiting more than 52 weeks, each averaged across the five financial years from 2020/21 to 2024/25. Only the 22 organisations with usable figures for all three measures in every year are included. The 18-week and 52-week figures are raw patient counts rather than population-adjusted, so larger organisations can score more highly partly because they serve more patients and because the period includes years affected by COVID-19 disruption. Results should be read as sustained pressure across five years rather than a normal pre-pandemic baseline.