Should the NHS Continue to Provide Free Healthcare for All? By Ellie Lau

Have you ever thought about this- what kind of society would we become if we start putting a price on health? The National Health Service (NHS) has been a cornerstone of British society since it was founded in 1948. Established on the principle that healthcare should be free at the point of use, it has come to symbolise fairness, solidarity, and the shared belief that access to medical treatment should depend on need, not income. In recent years, however, the NHS has faced escalating challenges, such as rising demand, workforce shortages, an aging population, and the long waiting lists. The current funding model, which is primarily reliant on general taxation, is struggling to keep pace with the growing needs of an aging population and the increasing costs associated with medical advancements. Preserving the NHS in its current universal model is not only the most just and equitable approach, but also the most effective in promoting public health, social cohesion, and economic productivity.

Central to the argument for a free NHS is the concept of equality. The founding principle that healthcare should be available to all, regardless of financial means, remains as vital today as it was in 1948. A system that is free at the point of use ensures that medical decisions are based solely on clinical need, not personal wealth. The alternative—introducing fees or means-testing—would disproportionately harm low-income groups, creating delays in seeking care and worsening health outcomes. International evidence supports this: a 2021 study published by the National Institutes of Health (NIH) showed that diabetic adults with coronary heart disease in the United States who struggled to afford healthcare experienced worse heart-related outcomes and less consistent access to treatment. Where patients face financial barriers, conditions that are initially treatable often escalate into chronic or life-threatening illnesses, ultimately incurring higher costs both for individuals and society. One of the examples I would like to bring up would be in acute stroke care, rapid diagnosis is essential. Advanced imaging techniques such as CT, MRI, MRA scans are crucial in determining the appropriate treatment. These diagnostic tools, however, are costly. If such scans are not freely accessible, financial barriers can delay or even prevent diagnosis. Healthcare is not simply a commodity to be bought and sold, it is a human right. The World Health Organization had mentioned that the highest attainable standard of health is a fundamental right for all people, regardless of socioeconomic status. The NHS reflects this moral commitment by ensuring that care is guaranteed to everyone in the UK. In contrast, privatisation or the introduction of insurance-based models would risk commodifying healthcare, transforming it from a shared societal good into a privilege accessible primarily to those who can afford it. Such systems often deepen existing inequalities by limiting access to essential services for those who are already economically disadvantaged, ultimately widening the gap between different social groups.

The funding model of the NHS reinforces the principle of collective responsibility. It is paid for through taxation, it ensures that everyone contributes based on their means and benefits according to their needs. This system not only makes healthcare more equitable but also helps build a powerful sense of national unity. In comparison, systems based on private healthcare often weaken public trust and create divisions between those who can afford care and those who cannot. Public opinion in the UK continues to reflect widespread support for the NHS’s founding values. According to The King’s Fund (2023), over 75% of the British public believe that the NHS should remain free at the point of use and funded through general taxation.

From an economic standpoint, the NHS’s focus on prevention is also highly effective. Free access to healthcare encourages individuals to seek help earlier, before conditions become severe or chronic. Preventative care, such as diabetes screening, smoking cessation programmes, and vaccinations, can significantly reduce long-term treatment costs. The King’s Fund (2023) found that for every £1 invested in prevention, the NHS saves £4 in future treatment costs. For example, managing diabetes early can help avoid serious complications such as amputations or kidney failure, both of which are far more expensive to treat. Similarly, national vaccination programmes reduce hospital admissions and the risk of widespread outbreaks, saving both lives and resources.

The wider economy also benefits from a healthy population. When people have access to timely and reliable healthcare, they are more likely to recover quickly from illness, take fewer sick leaves, and remain in employment longer. This not only helps individuals maintain financial stability but also supports businesses by reducing absenteeism and improving productivity. Moreover, universal access to healthcare reduces dependence on state support such as sickness-related benefits or long-term disability payments, thereby easing pressure on the welfare system. According to the Institute for Public Policy Research (IPPR), poor health costs the UK economy around £150 billion each year in lost productivity, more than the entire annual budget of the NHS. These figures highlight the financial strain that widespread ill health had placed on both employers and government finances. A system that supports early diagnosis, preventative care, and long-term condition management allows people to contribute more consistently and effectively to the workforce. By keeping the population healthier for longer and ensuring that care is based on need rather than ability to pay, the NHS supports not only individual well-being but also the broader economic resilience of the UK. Universal healthcare, in this sense, is both a public good and a strong backbone of national productivity.

Despite these advantages, the NHS is facing many challenges. As of 2024, over 7.8 million people were on hospital waiting lists in England, and services are struggling to meet the demand. An aging population, rising rates of chronic disease, and expensive new medical technologies all contribute to the burden. The NHS is also facing a workforce crisis. NHS Digital reports that there are more than 110,000 staff vacancies across the service, including 40,000 nurses and 8,000 doctors. Brexit has worsened staffing shortages by reducing the number of EU-trained healthcare professionals, while the COVID-19 pandemic has left many NHS workers exhausted and burned out.

These challenges, however, are not a reason to abandon the NHS. Fortunately, the UK government appears to recognise this need. In the 2025 Spending Review, it pledged an additional £29 billion in day-to-day NHS funding by 2028–29. This will raise the total NHS resource budget to £226 billion and includes targeted investments in digital transformation, upgraded infrastructure, and expanded training for medical professionals. Plans also include increasing GP and dental appointments, improving digital services via the NHS App, and boosting community-based care to ease hospital pressures.

Staffing is the make-or-break issue for the NHS in England. While funding alone is not enough, experts from The King’s Fund and the Nuffield Trust have emphasised the need for a broader and more balanced strategy. This includes increasing the number of medical training places, improving salaries and working conditions to retain current staff, and more importantly speed up the visa process to make it easier for overseas healthcare workers to support the NHS workforce. Another major change the NHS should take is to keep up with technological developments, for instance, adopting AI-assisted diagnostics and virtual consultations to improve efficiency. At the same time, public health campaigns that encourage healthier lifestyles and help reduce preventable illnesses will be key in managing long-term demand.

Some people argue that the UK should consider using other countries’ healthcare systems for alternatives. Insurance-based models in countries like France and Germany do provide high-quality care and sometimes shorter waiting times. However, these systems are costly and compromised. France spends 11.9% of its GDP on healthcare, higher than the UK’s 10% and still requires patients to pay out-of-pocket for many services. In the United States, the privatised system spends 18% of GDP on healthcare, yet around 30 million Americans remain uninsured, medication costs are drastically inflated, and critical medications such as insulin can cost ten times more than in the UK. Hybrid systems in countries like Sweden or Australia, often result in two-tier care where public services become underfunded as wealthier individuals opt for private alternatives, drawing resources away from the universal system.

In answering the central topic whether the NHS should continue to provide free healthcare for all, to a larger extent, it is a yes. A system that guarantees healthcare based on need rather than ability to pay is not only morally justified, but economically and socially unifying. The NHS aims to ensure equality, protect public health and contribute to national productivity by promoting early intervention and preventative care. Although the service is under high pressure, these all reflect a need for reform, not a replacement. Ideas of shifting to a paid or insurance-based system would likely increase the problem of inequality, introduce financial barriers and contradict the ethos on which the NHS is built on. Therefore, instead of questioning whether healthcare should remain free, the more we should focus on now is to modernising, funding, and safeguarding the NHS so it can continue to deliver high-quality care. As Aneurin Bevan, the NHS’s founder, once said, “The NHS will last as long as there are folk left with the faith to fight for it.”