A trade deal struck between Britain and the United States could force the NHS to divert almost £45 billion away from frontline healthcare over the next decade to pay higher prices for medicines, according to analysis published in the British Medical Journal. Researchers estimate the consequences could be catastrophic, with 229,000 excess deaths by 2036 if health services are cut to meet the additional costs. If knock-on effects on adult social care are included, the death toll could rise to 291,000.
The analysis, carried out by researchers from the University of York, the University of Liverpool and Christchurch Hospital in New Zealand, is the first to estimate the likely impact of the UK-US agreement on NHS spending and public health.
The figures expose the real priorities behind the deal. While ministers describe it as a “landmark” agreement that will improve access to new medicines and protect British pharmaceutical exports from US tariffs, the cost is set to fall on the working class through an already overstretched health service.
Under the agreement reached last December, Britain committed to paying 25 percent more for new medicines over the next decade. The NHS in England will also double the share of GDP devoted to purchasing innovative medicines, rising from 0.3 percent to 0.6 percent.
According to the BMJ analysis, unless the government provides entirely new funding to cover those higher costs, £44.7 billion will have to be redirected from existing NHS budgets by 2036. That’s money that would otherwise pay for staff, hospital services, GP appointments, preventative care and treatment for long-term illnesses.
Researchers concluded that such cuts would disproportionately affect patients suffering from heart disease, respiratory illness, gastrointestinal disease and cancer.
This isn’t simply a debate about healthcare funding. It’s an example of how the capitalist state manages competing interests. While governments often claim there’s never enough money to properly fund public services, vast sums can always be found when the interests of powerful corporations are involved.
The pharmaceutical industry occupies a privileged position within modern capitalism. Protected by intellectual property laws and backed by some of the world’s largest monopoly corporations, it enjoys enormous political influence. Trade agreements increasingly serve not just to reduce tariffs, but to strengthen the ability of these monopolies to extract profits across national borders.
The pressure surrounding this agreement reportedly came after Donald Trump threatened tariffs of up to 100% on some medicines imported into the United States. Rather than risk disruption to pharmaceutical exports, the British government accepted terms that critics argue shift the financial burden directly onto the NHS.
Campaign group Global Justice Now previously warned the agreement would force the NHS to cut services “to pacify Donald Trump and big pharma’s demand for higher medicines prices.
The government’s own estimates bear little resemblance to the independent analysis. Ministers claim the agreement will cost only £1 billion between 2025-26 and 2028-29, while acknowledging costs will increase afterwards without providing figures. By contrast, the BMJ research projects annual costs rising to £8.8 billion by 2036.
The government has also refused repeated calls from MPs to publish its own impact assessment of the agreement.
Sir Ciarán Devane, chief executive of the NHS Alliance, said the findings raise “serious questions” about whether the deal represents value for patients or 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. 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.”
Tim Bierley of Global Justice Now argued that the agreement represents a direct transfer of public wealth into corporate profits.
“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. As the research shows, if money is diverted from other critical parts of our NHS to pay for this deal, this would lead to hundreds of thousands of deaths.
“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 of Just Treatment described the projected consequences in stark terms.
“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 Department of Health and Social Care rejected the £45 billion estimate, insisting the figure is not recognised by the department. It argues that the agreement will expand access to new medicines and that future costs will be covered through spending review allocations.
Whether or not the government’s lower estimates prove accurate, the dispute itself highlights a deeper contradiction. Under capitalism, healthcare is continually pulled between two opposing pressures: the need to keep people healthy, and the drive of monopoly capital to maximise returns. When access to medicines becomes another avenue for profit extraction, public health inevitably comes into conflict with private accumulation.
Supporters of the agreement present it as the price of maintaining Britain’s place within the global pharmaceutical market and preserving trade with the United States. But from a class perspective, the question is who pays that price. If independent researchers are even close to correct, it won’t be pharmaceutical shareholders or corporate executives. It will be ordinary people facing longer waiting lists, reduced services and, ultimately, preventable deaths.
That’s the logic of imperialist capitalism in practice: international agreements designed to secure the interests of monopoly capital, with working people left to absorb the cost.
