Thomas Griffin is the Global Ambassador for the Conservative Policy Forum and the Zurich Representative for Conservatives Abroad.
Britons cherish the idea of the National Health Service as “free”.
“Free at the point of delivery,” the founding slogan declared in 1948. Over time, the phrase has been whittled down in the national imagination to just “free”. It never was.
The NHS’s first pamphlet made that clear: “It is not a charity. You are all paying for it, mainly as taxpayers.”
That distinction has faded. When voters forget that they fund the service themselves, discussion of its sustainability turns sentimental. To make the NHS fit for the future, Britons need a reminder of what it costs—and what they can do to reduce that cost. One way would be to offer NHS tax rebates to people who help lower its burden by avoiding the diseases that need not exist.
Roughly 40 per cent of NHS spending goes on preventable conditions. Out of a £180bn annual budget, that means more than £70bn treating illnesses that could, in principle, be avoided. Cardiovascular disease alone costs around £18bn a year. The World Heart Federation reckons that four-fifths of cases could be prevented through healthier diets, regular exercise and abstention from smoking.
A rebate remedy
Private insurers around the world already reward good behaviour: gym-goers earn cashback, non-smokers get discounts. A similar idea could work for taxpayers. Those who can show sustained participation in exercise programmes, sports clubs or verified health schemes could qualify for a modest rebate. The mechanics—what counts, how to prove it—would need careful design. But the technology and data already exist, and other countries have made such schemes work.
The key would be simplicity. Rebates should be voluntary and non-punitive: not a moral cudgel, but a financial nudge. They would return a small portion of one’s own money as recognition for helping keep collective costs down. Some people would cheat; some would benefit without trying. So be it. Most public policies suffer the same imperfections, and the savings—both fiscal and social—could easily outweigh them.
Changing minds, not just waistlines
If the NHS cut even a fifth of its preventable spending, the gains would be enormous. But the larger prize lies in perception. Framing the system as a partnership between taxpayer and state would remind citizens that health is both a personal duty and a shared good. The idea of an NHS rebate could rekindle a sense of individual responsibility without dismantling universality.
Critics will cry “privatisation by stealth”. It is nothing of the sort. The rebate would not charge for care or restrict access; it would simply acknowledge those who lighten the load. Others will call it fiddly. Perhaps—but less so than rationing, waiting lists or endless emergency budgets.
The NHS’s problems will not be solved by ever-larger cheques. They require a shift in how Britons think about their health and their state. A small, symbolic tax rebate could help deliver that shift. It would remind the public that the NHS is sustained not by benevolence, but by their own pockets.
The service was founded on collective responsibility. Seventy-seven years later, it could use a gentle reminder that collective responsibility begins with individuals. A rebate for good health would not just save money—it would remind Britons what “free” really costs.
