Your cost per click went up 22% (don't blame your agency!)

We compared April to June 2026 against the identical campaigns in the same quarter of 2025. Same accounts, same campaigns, same season, twelve months apart.

Blended cost per click up 22%, from £1.07 to £1.30.

Blended cost per acquisition up 29%, from £14.08 to £18.13.

Click through rate broadly flat, 7.45% to 7.22%.

If click through rate had collapsed you could blame tired creative. What we are seeing is the auction price changing.

Demand is growing, and it is pulling in new bidders. NHS waiting lists keep pushing first time self pay patients into search, and that has attracted competitors into auctions incumbents used to own: insurers, private equity backed clinic groups, and single specialty challengers going after one profitable slice of a hospital’s business.

There are fewer clicks to go round. AI Overviews and AI assistants are answering the research questions that used to produce a visit. Less volume, more advertisers, same auction. The price only moves one way.

Everyone is bidding the same way. Almost nobody runs manual bidding any more. Value based smart bidding means every competitor’s system is hunting the same subset of people, the ones most likely to book and pay, and those systems get sharper every quarter. Undervalued pockets get arbitraged away inside a couple of quarters.

Not everything went up. Gynaecology and urology clicks got cheaper over the same period, while their auction pools held or contracted. If you operate in one of those, this is the cheapest share you will buy for a while, and the window will not stay open indefinitely.

This is also a warning about how you read data like this. You will see plenty of aggregated cost per click reporting this year: healthcare up x%, retail up y%, financial services up z%. Inside this one sector the spread runs from falling prices to +144%. A sector average would have told you nothing useful about either end of it.

Track direction at specialty level. Account averages hide both the problem and the bargain, and industry averages hide even more.

Joe’s read across the accounts he manages is that conversion rates have mostly not moved. What has moved is the price of filling the top of the funnel. Standing still now costs more, which means the recovery has to come from conversion.

The arithmetic depends on where your conversion rate starts. Take a 5% conversion rate to 6% and you have absorbed a 20% rise in cost per click at a flat cost per acquisition. That is roughly this year’s inflation, recovered without touching a bid.

Where that percentage point usually comes from: pointing each keyword at the page that actually answers it, cutting form length, putting self pay pricing and finance options in front of the patient at the moment they are deciding, and being far more aggressive about which intents you are willing to pay for in the first place.

For hospital groups and multi service providers, the annual habit of dividing budget across services and letting it run is no longer defensible. Overweight the specialties where cost per click is falling and the auction pool is holding. Demand efficiency where inflation is outrunning demand growth. Treat the allocation as a live position and review it every quarter.

There is a concentration risk to deal with too. The accounts feeling this hardest are the ones most heavily invested in high intent, lower funnel search, because that is the most contested part of the auction. If every pound sits there, you have no shock absorber when prices move. Channel diversity is what buys you one.

This is the same argument we made across our e-commerceification series, arriving from the other direction. Once you know what a patient is worth across five years of treatment, you can afford to pay more than a competitor who only prices the first consultation. Lifetime value is what lets you win an inflationary auction on purpose, or sit it out on purpose.