The NHS will have to divert £45 billion from essential services to pay for new medicines under the terms of the UK-US trade deal agreed last December, leading to more than 200,000 avoidable deaths of patients, according to new analysis published in the British Medical Journal.
Ministers have defended the deal as a way of helping British drug exports to the US avoid tariffs and giving patients in England access to potentially life-extending drugs. But they have been accused of caving in to US demands to spend billions of pounds a year extra on drugs supplied to the NHS after pressure from President Donald Trump.
The analysis, from the University of York, the University of Liverpool, and Christchurch Hospital in New Zealand, lays bare the likely cost of the deal to the NHS — and the projected deadly impact of cuts to health services on the population in England — for the first time.
The Cost and the Toll
In total, £44.7 billion in NHS cash will be diverted from health services by 2036 in order to pay more for new medicines under the trade deal, unless extra funding is made available to cover the additional costs, the analysis suggests.
Reduced NHS spending on services will have an adverse effect on the nation’s public health, causing 229,000 excess deaths by 2036. The estimated avoidable death toll is larger than the number that occurred during the COVID-19 pandemic in England between March 2020 and June 2022. If the indirect effect on adult social care was also included, excess deaths would increase to 291,000.
Most of the preventable deaths would be among people with heart, respiratory, gastrointestinal diseases, or cancer.
The Deal
When the agreement was reached last December, ministers hailed the deal as a “landmark” to “safeguard medicines access and drive vital investment for UK patients and businesses.” The UK agreed to pay 25% more for new medicines over the next decade. The deal will also see the health service in England, which currently spends £14.4 billion a year on innovative therapies, double the percentage of GDP it allocates to buying such products, from 0.3% to 0.6% over the next decade.
Ministers and drug industry bosses said the deal was good news because it would let British-made drugs sold to the US avoid tariffs of up to 100% that Trump threatened to impose on some medicines being imported into the US. The government says the deal will cost only an extra £1 billion between 2025-26 and 2028-29. It has admitted costs will rise after 2028-29 but has not given any estimates.
However, the BMJ analysis suggests the annual cost to the NHS will surge to £8.8 billion by 2036, with the total bill hitting £44.7 billion by the end of that year.
The Reaction
MPs and campaign groups voiced scepticism. The UK-based campaign group Global Justice Now warned the deal would lead to the NHS axing services “to pacify Donald Trump and big pharma’s demand for higher medicines prices.”
Sir Ciarán Devane, the chief executive of the NHS Alliance, said the analysis raised “serious questions” over whether the trade deal represented value for patients or for the NHS. “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,” he said.
Helen Morgan, the Liberal Democrat health spokesperson, called on the government to urgently publish its own impact review, saying it was “crazy” that billions of pounds in NHS funding were being spent on placating Trump.
Tim Bierley of Global Justice Now said: “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.”
Diarmaid McDonald of Just Treatment added: “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.”
The Government’s Response
A Department of Health and Social Care spokesperson said: “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 £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.”
The Bottom Line
Analysis published in the British Medical Journal warns that the UK-US trade deal could cause 229,000 excess deaths in England by 2036 as the NHS diverts £45 billion from essential services to pay for higher medicine costs. The UK agreed to pay 25% more for new medicines to avoid US tariffs threatened by President Trump. Critics say the deal benefits big pharma at the expense of patients. The government has defended the agreement, saying it will give patients access to life-changing drugs, but has faced calls to publish a full impact assessment.
