BMJ analysis warns UK-US drug deal could drain NHS care and risk 229,000 excess deaths

A new analysis has intensified scrutiny of a UK-US medicines agreement after researchers warned it could force the NHS to divert tens of billions of pounds from everyday care to higher drug costs.

The warning centres on the NHS pharma deal agreed between Keir Starmer’s government and Donald Trump’s administration in December. Ministers presented the agreement as a way to protect British pharmaceutical exports from US tariffs while improving access to new branded medicines for patients.

The latest analysis, published in the British Medical Journal, paints a darker picture. Its authors estimate that the English NHS could face an additional £44.7bn bill by 2036 unless the government provides extra money to cover the costs. They also warn that reduced spending on other services could lead to 229,000 excess preventable deaths by 2036.

That figure has turned a technical trade dispute into a political crisis about what the health service can afford to lose. The researchers argue that more money spent on branded drugs means less money available for other care, including scans, staff, long-term disease treatment and routine services that keep patients alive.

The NHS pharma deal has also revived questions about transparency. According to the article, MPs did not get a full chance to examine the changes before they became law. The measures went through by statutory instrument, a process that can limit the level of parliamentary debate around major policy changes.

At the time of the agreement, then-health secretary Wes Streeting said the NHS was not on the table and said services would not be cut to fund the arrangement. He also said the cost would be around £1bn a year over the next couple of years. The BMJ analysis now suggests the early annual pressure could be much higher, with costs rising further by the end of the decade.

The government has rejected the scale of the figures. The Department of Health and Social Care said it does not recognise the £45bn estimate and argues that the agreement will help patients access life-changing medicines. It has also presented the deal as part of a wider push to support UK life sciences and protect exports to the United States.

Critics say that defence misses the central question. If the money comes from the NHS budget, they argue, the NHS pharma deal would shift resources away from services that already save lives at scale. The BMJ authors say the benefits claimed for higher medicine prices remain uncertain, while the pressure on other NHS care could be severe.

The political timing adds to the tension. Starmer has said he will step down once Labour chooses his successor, and Andy Burnham is widely expected to inherit the government later this month. That puts the NHS pharma deal on the desk of a likely new prime minister before the row has received the full scrutiny critics demand.

For patients, the dispute is not about trade jargon. It is about whether hospitals, clinics and community services will have enough money for the care people need every day. The analysis suggests the cost of the NHS pharma deal could be counted not only in billions, but in lives.

The unanswered question now is whether ministers will publish the full impact assessment and allow Parliament to test the agreement in public. Until then, a deal sold as a boost for medicines will remain under a growing shadow.

That uncertainty is why the NHS pharma deal has moved beyond Westminster procedure and into a wider argument about democratic accountability. A policy sold as technical may now define how far ministers can reshape the NHS without first showing voters the full price.