Is Spravato Covered on the NHS? UK Guide (2026)

It depends where you live — and for most of the UK the answer is no. NICE did not recommend esketamine (Spravato) for treatment-resistant depression in technology appraisal TA854, so it is not routinely commissioned in England and Wales, and Northern Ireland endorsed the same appraisal. Scotland is the exception: the Scottish Medicines Consortium accepted Spravato for restricted use, so NHS Scotland patients have a route via their psychiatrist. This page covers both answers — how the Scottish route works, what the gap costs you in England, and where the first NHS ketamine pilots fit; the eligibility decision itself always sits with a clinician, and you can begin orienting yourself with our eligibility check.

What is covered

One licence, three answers. Esketamine nasal spray is licensed UK-wide, but NHS funding is decided nation by nation:

England and Wales: nothing routine. In TA854, NICE concluded that esketamine's cost-effectiveness case for treatment-resistant depression was not made and did not recommend it for routine NHS use. In practice a GP or psychiatrist cannot simply prescribe Spravato on the NHS.
Northern Ireland endorsed the same decision rather than issuing its own separate recommendation.
Scotland: covered, restricted. The Scottish Medicines Consortium accepted esketamine (SMC2258, 2020) for restricted use in treatment-resistant depression under a patient access scheme, implemented through the health boards.

One development to watch: the NHS has begun piloting racemic ketamine within existing depression care pathways, through programmes at Oxford Health NHS Foundation Trust and Central and North West London NHS Foundation Trust (Magnetar/Blossom reimbursement report, 2025). These are limited-capacity services accessed through NHS referral, not something you can book directly — but they are the first crack in the "private-only" picture.

Who qualifies

In Scotland, the SMC restriction targets treatment-resistant depression — no response to at least two failed antidepressants in the current episode — with assessment by a psychiatrist and delivery subject to local health board arrangements. Where esketamine is given, you self-administer the spray under supervision, stay for roughly two hours of observation, and continue an oral antidepressant alongside.

In England, Wales and Northern Ireland there is no routine NHS entitlement to qualify for. The realistic doors are the NHS ketamine pilots (via referral, limited capacity), private clinics, and clinical trials — covered below.

Everywhere, the practical currency is a written treatment history: every antidepressant tried in the current episode, with dose, duration and outcome. Bring it to the first appointment — it does more work than anything you say in the room.

Who decides and how to apply

Scotland: ask your psychiatrist directly about the esketamine pathway in your health board area — do not assume the England picture applies to you. The SMC has accepted the medicine; the health board's local arrangements and the psychiatrist's assessment of documented treatment resistance decide the individual case.

England and the rest of the UK: with the NHS route closed, the decision-maker is effectively the private clinic's own medical screening. Independent clinics must be registered with the Care Quality Commission in England (or the Scottish and Welsh equivalents) — check the clinic's CQC profile and rating, and the prescriber on the GMC register, before paying anything. To compare who is listed, browse providers in the UK; for the full picture of every legal route, see our UK access guide.

What it costs you

In Scotland, treatment under the SMC acceptance is covered by NHS Scotland.

In England, the gap is priced in pounds: expect roughly £300–800 per private ketamine infusion, with typical London pricing around £595 per infusion plus an initial consultation, and full ketamine-assisted psychotherapy programmes running from about £6,000 for six weeks. A small number of specialist services exist inside the NHS itself but on a self-funded basis — the ketamine service at Oxford Health suggests budgeting around £3,000 per year. Private clinics offering Spravato itself also exist; ask for the full course cost in writing.

If you do not qualify

If the NHS route is closed where you live, the honest fallbacks are:

NHS ketamine pilots. The Oxford Health and CNWL programmes run racemic ketamine within existing depression pathways — limited capacity, accessed through NHS referral, and worth raising with your psychiatrist.
Private CQC-registered ketamine clinics, at the prices above, after the clinic's own medical screening. Red flags matter doubly in a self-pay market — no psychiatric screening before payment, guaranteed results, pressure to prepay long packages; our clinic-choice guide has the full checklist.
Clinical trials are free by definition, and the UK runs one of Europe's busiest programmes — 67 UK-linked studies tracked, 12 active, with psilocybin trials genuinely recruiting in 2026. See the trials guide for how to search.

Frequently asked questions

Is Spravato covered on the NHS?

In England, Wales and Northern Ireland, no — NICE's TA854 decision means it is not routinely commissioned, so there is no standard NHS prescription route. In Scotland, yes with restrictions: the SMC accepted it for treatment-resistant depression under a patient access scheme, via psychiatrist assessment and health board arrangements.

I live in Scotland — how do I start?

Ask your psychiatrist about the esketamine pathway in your health board area. The assessment turns on documented treatment resistance, so bring your written medication history — every antidepressant tried in the current episode, with dose, duration and outcome.

Why did NICE say no when most of Europe said yes?

NICE concluded the cost-effectiveness case was not made at the offered price — a national funding judgment, not a safety one; the same drug with the same evidence met different price-per-benefit thresholds across Europe. See the Europe-wide reimbursement map for how the decisions compare.

Is private ketamine treatment legal?

Yes. Off-label prescribing by a licensed doctor is lawful, and the clinic must be CQC-registered (in England) as an independent healthcare provider. Legal does not mean uniformly good — check the CQC rating, the prescriber's GMC number, the screening process and the full course cost before paying.

Sources

This guide is for general information only and is not medical advice, a diagnosis, or a recommendation of any treatment. Regulations and reimbursement rules change; always verify current requirements with your insurer and discuss your options with a licensed clinician who knows your history. If you are in crisis, contact your local emergency number or a crisis line immediately.

This guide awaits review by a licensed medical professional.

Is Esketamine (Spravato) Covered on the NHS? England vs Scotland (2026)

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