The NHS will have to divert £45bn from essential services to pay for new medicines under the terms of the UK-US trade deal agreed last December, a diversion of funding that analysis suggests will lead to more than 200,000 avoidable deaths of patients in England.
Ministers have defended the deal as a way of helping British drug exports to the US avoid tariffs, while giving NHS patients earlier access to potentially life-extending medicines. But the government has faced sustained accusations of caving to pressure from Donald Trump to spend billions of pounds a year extra on medicines supplied to the NHS, and health experts have expressed growing alarm at the deal’s likely impact on frontline care.
What the analysis found
New peer-reviewed research, published in the British Medical Journal and carried out by academics at the University of York, the University of Liverpool and Christchurch Hospital in New Zealand, quantifies that impact for the first time. In total, £44.7bn in NHS funding will be diverted from health services by 2036 to cover the higher cost of new medicines agreed under the trade deal, unless the government provides additional funding to cover the difference.
The reduction in spending on other NHS services is projected to cause 229,000 excess deaths in England by 2036, a toll larger than the number of deaths recorded during the Covid-19 pandemic in Britain between March 2020 and June 2022, which stood at 137,000. If the indirect impact on adult social care is included as well, the researchers estimate the excess death toll rises to 291,000. The majority of these preventable deaths would occur among people with heart disease, respiratory illness, gastrointestinal disease or cancer, the conditions most dependent on the kind of frontline and preventative services likely to be cut to fund the deal.
What the deal actually involves
When the agreement was reached last December, ministers described it as a “landmark” deal to “safeguard medicines access and drive vital investment for UK patients and businesses.” Under its terms, the UK agreed to pay 25% more for new medicines over the next decade. The deal also commits the NHS in England, which currently spends £14.4bn a year on innovative therapies, to double the proportion of GDP it allocates to purchasing such products, from 0.3% to 0.6%, over the coming ten years.
The rationale offered by ministers and pharmaceutical industry executives was that the deal would allow British-made drugs exported to the US to avoid tariffs of up to 100% that Trump had threatened to impose on certain medicine imports. In exchange, the NHS agreed to a substantially higher price structure for new drugs going forward.
The scrutiny problem
MPs from Labour and several opposition parties have repeatedly urged the government to publish its own impact assessment of the December agreement, which was negotiated and concluded without parliamentary scrutiny beforehand. The government has so far said the deal will cost only an extra £1bn between 2025-26 and 2028-29, while acknowledging costs will rise significantly after that period, without providing its own estimate of by how much.
In February, science minister Patrick Vallance disclosed that the costs of the deal would be borne directly by the Department of Health and Social Care, meaning the funding pressure falls on the NHS budget itself rather than being absorbed by the Treasury more broadly. The BMJ analysis suggests the annual cost to the NHS will rise to £8.8bn by 2036, with the cumulative total reaching £44.7bn by the end of that year.
The reaction
Sir Ciarán Devane, chief executive of the NHS Alliance, which represents healthcare systems across England, Wales and Northern Ireland, said the analysis raised “serious questions” about whether the deal represents value for patients. “If billions of pounds are diverted away from frontline care to meet higher medicines costs, the consequences for prevention, community services and the treatment of long-term conditions could be profound. The government must urgently publish the full impact assessment and ensure there is appropriate scrutiny of the deal if it could have such far-reaching implications for population health.”
Liberal Democrat health spokesperson Helen Morgan called the findings “alarming” and pressed the government to publish its own review. “It is crazy that billions of pounds in NHS funding are being spent on placating Donald Trump,” she said. “It is a complete insult to patients who are suffering and dying on hospital trolleys and waiting months for treatment. We cannot afford to sit by while our NHS is picked apart by a foreign regime. We need to defend our NHS with everything we have and firmly stand up to the bully in the White House.”
Tim Bierley of Global Justice Now went further, describing the deal as a direct transfer of resources from the NHS to the pharmaceutical industry. “Billions that could be spent on recruiting more NHS staff, cutting GP waiting times, or improving our hospital care are set to be siphoned off by corporate giants in the pharma industry,” he said. “Scandalously, this backroom deal was not subject to any scrutiny in parliament before being rushed through, and the government refuses to say what impact it will have on the NHS. The next prime minister must change direction, stand up for our NHS, and unpick the mess left by their predecessors.”
Diarmaid McDonald, executive director of Just Treatment, was similarly blunt. “These numbers should shock people to their core. Tens of billions of pounds taken out of the NHS budget and put into the back pockets of the pharmaceutical industry, placing hundreds of thousands of lives at risk. Across the country, our parents, our grandparents, our loved ones, dying unnecessarily in order to inflate drug company profits and please Donald Trump. This is a national scandal.”
The government’s response
A Department of Health and Social Care spokesperson defended the deal, saying: “Through our partnership with the US, we have reformed medicine pricing, allowing NHS patients to access life-changing new medicines they previously would have been denied. We are also making the UK one of the best places in the world to develop, launch and manufacture new medicines.” The spokesperson disputed the headline figure directly: “The £45bn figure is not recognised by the department. The deal will be funded by allocations made at the spending review, where record funding for the NHS was secured. Future funding will be settled at the next spending review.”
That response does not directly engage with the BMJ analysis’s methodology or its central finding on excess deaths, leaving campaigners and health bodies to continue pressing for the government’s own impact assessment to be made public, something ministers have so far declined to do.
Why this matters now
The timing of the analysis is significant. It arrives as Britain approaches a change of prime minister, with campaigners including Global Justice Now explicitly calling on Burnham’s incoming government to revisit the agreement rather than simply inherit it unchanged. Whether an incoming administration facing its own pressures on NHS funding, defence spending and fiscal rules chooses to reopen a trade agreement already struck with the Trump administration is a question that will likely define one of the earliest and most consequential health policy tests of the new government.
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