Each year, the European Federation of Pharmaceutical Industries and Associations publishes its Patients W.A.I.T. report, tracking how quickly newly approved medicines reach patients in national health systems across Europe. The 2026 edition, covering medicines approved by the European Medicines Agency between 2021 and 2024, places England seventh out of 36 countries. Roughly four in ten EMA-approved medicines remain unavailable to NHS patients in England.

England's overall ranking of seventh reflects that 61% of EMA-approved medicines have received both MHRA authorisation and a positive NICE recommendation for NHS use. Scotland sits eleventh, at 53%. Compared to similar European economies, England ranks fourth, trailing Germany, Italy, and Spain. However, these figures represent only part of the overall situation. When the analysis is narrowed to medicines available without restriction, meaning on the same terms as their regulatory licence, England falls to tenth place. Just 33% of medicines licensed during this period are available to NHS patients on a full, unconditional basis. The remainder either cannot be accessed at all or carry NICE recommendations that exclude many of the patients for whom a medicine is formally approved.

The data is sharpest for cancer patients and those with rare diseases. Access to cancer medicines in Europe varies significantly across the UK nations. England ranks fourteenth, with 59% of these medicines available through the NHS, while Scotland falls further behind at nineteenth, with only 48% accessible. For orphan medicines, which are developed specifically for rare conditions with few existing treatment options, England ranks eleventh at 50% and Scotland thirteenth at 47%. For patients with rare diseases, the practical consequence of these gaps is often stark: where only one or two treatments exist for a given condition, being outside the criteria for an approved medicine can mean having no treatment option at all.

One area where performance has improved is speed. From MHRA approval to an NHS access decision, England now ranks fifth in Europe at 332 days, with Scotland sixth at 347 days. Both represent an improvement on the previous dataset. Even so, neither country has returned to the timelines achieved before 2024, and the report notes that further progress is needed.

The decline in overall availability reflects pressure at several points in the approval process. A significant upstream factor is licensing: around one third of medicines approved by the US Food and Drug Administration are never licensed in Europe or the UK, removing them from the pipeline entirely before MHRA or NICE consideration begins. For medicines that do receive a UK licence, the path to NHS availability involves MHRA authorisation, a NICE appraisal, and commercial negotiations with manufacturers. Delays or failures at any stage can result in medicines that are approved as safe and effective but remain inaccessible to patients.

The government has acknowledged the problem. Commitments made as part of the UK-US pharmaceutical arrangement included measures intended to improve the commercial environment for new medicines. NICE has also revised its cost-effectiveness threshold, the benchmark used to determine whether a medicine represents sufficient value for NHS spending, a change designed to bring more medicines within reach of a positive recommendation.

The W.A.I.T. report offers a clear measure of where the UK stands relative to its European neighbours, and the 2026 edition shows a country making incremental gains on speed while continuing to fall short on availability. The policy changes announced over the past year may shift that picture, but their effect will only become visible in future editions of the report. Until then, the distance between England's rankings and those of Germany or France remains a practical consequence for patients waiting for treatments their counterparts elsewhere in Europe can already access.

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