The UK is often celebrated and admired for its National Health Service, a.k.a the NHS. For decades, people have been able to access medical treatment without directly paying for it at the point of use. But is the healthcare in the UK truly ‘free’ or is there more to the story?
Due to the NHS being funded mostly via taxation, it is subject to limitation. In 2022, about 20% of all public spending went to health services. In simple terms, healthcare is free at the point of use, but not free in the broader sense because it’s paid for collectively by taxpayers.
whether certain treatments are truly free or available at all is largely influenced by the National Institute for Health and Care Excellence (NICE). This government body plays a critical role in deciding which drugs, treatments, and medical procedures the NHS offers based on both clinical and financial considerations.
NICE ensures that healthcare resources are used efficiently, balancing the needs of individual patients with the realities of a limited budget. But how does this process work, and what does it mean for the concept of “free” healthcare?
NICE evaluates the clinical and cost-effectiveness of treatments to determine if they should be available on the NHS. Its primary goal is to ensure that patients receive care backed by strong evidence while ensuring the public funds the NHS relies on are spent wisely. This involves carefully analyzing whether a treatment is beneficial enough to justify its cost.
NICE uses several key criteria when making decisions:
- Clinical Effectiveness: NICE examines whether a treatment works and how it compares to existing options. For example, does a new drug offer better survival rates, fewer side effects, or improved quality of life?
- Cost-Effectiveness: Treatments are assessed using a measure called QALY (Quality-Adjusted Life Year), which compares the cost of a treatment to the length and quality of life it provides. If a treatment costs less than £20,000–£30,000 per QALY gained, it is typically approved. More expensive treatments with limited benefits may be rejected.
- Population Impact: NICE considers how a treatment affects the broader population. Treatments that benefit large groups of people or tackle widespread health challenges, like vaccines, are prioritized.
- Budget Constraints: The NHS has finite resources, so NICE must ensure that treatments offer the best value for money. This often leads to difficult decisions when demand exceeds funding.
So essentially, if the government body deems a drug too expensive or not effective enough, it is not going to be provided on the NHS. Should our treatment really be subject to monetary limits? NICE’s decisions often highlight the tension between offering the best possible care and managing public funds responsibly.
On one hand, NICE has approved numerous life-saving treatments for conditions like cancer, diabetes, and rare diseases when they meet cost-effectiveness thresholds. For instance, some immunotherapy drugs for cancer have been approved after manufacturers agreed to negotiate lower prices.
On the other hand, NICE has rejected treatments that provide only marginal benefits at a high cost. A controversial example is the rejection of certain cancer drugs that extend life by only a few months but cost hundreds of thousands of pounds. While these decisions are based on sound reasoning, they can feel deeply unfair to patients affected by rare or complex conditions. Does it feel ethical to judge whether those few extra months of someone’s life will be granted by cost considerations?
While the UK’s healthcare system remains one of the most equitable in the world, the influence of NICE highlights the challenge of balancing individual patient needs with the broader demands of a publicly funded system. I don’t think that the methods in place for determining whether we get our healthcare treatments are as known about s they should be. It’s important that we are aware of these limitations, so we know whether we want to advocate for change.