Thanks to Dottie for alerting us to this:
From the Canary fact checker yesterday:
Keir Starmer’s disastrous trade deal with Trump for US pharmaceuticals may end up costing the UK £64bn. That’s massively over the £1bn estimate that the government itself gave to the public. Worse still, the money diverted from other NHS services may cost hundreds of thousands of lives over the coming decade.
That’s according to explosive reporting from the Bureau of Investigative Journalism. The Bureau, in turn, used economic modelling from a team at the University of York, lead by professor Karl Claxton. This professor previously sat on the appraisal committee for the the National Institute for Health and Care Excellence (NICE), the national body which decides which pharmaceuticals the NHS can purchase.
Claxton found that the UK government’s £1bn estimate of the deal’s most immediate costs should be closer to £3.3bn. However, he also argues that number will balloon to £64bn when we take account of the government’s commitment to double its pharmaceutical spending levels by 2036.
If this eye-watering figure proves accurate, the effects on public health in the UK could be devastating. Claxton’s team predicted that an extra 330,000 people could die within the next decade as a consequence of money being diverted from other NHS services to meet the deal’s demands.
Full report at: https://www.thecanary.co/uk/analysis/2026/04/16/starmer-pharma/
Will Scotland’s devolved NHS not protect us from this?
No, because:
NHS spending on branded medicines and setting rebates) is negotiated by the Department of Health and Social Care on behalf of all four UK nations, including the Scottish Government though it was not involved in the negotiations.
https://assets.publishing.service.gov.uk/media/657b2977095987001295e139/2024-voluntary-scheme-for-branded-medicines-pricing-access-and-growth.pdf https://assets.publishing.service.gov.uk/media/657b2977095987001295e139/2024-voluntary-scheme-for-branded-medicines-pricing-access-and-growth.pdf
Extra costs for new medicines must be met from NHS budgets across the UK, including Scotland and drug companies operate on a UK market.
https://www.thecanary.co/uk/analysis/2026/04/16/starmer-pharma/
The Scottish Government has protested but neither the Secretary of State for Scotland nor any Scottish Labour MP has criticised the deal made by Sir Keir Starmer on our behalf.
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Seems like another example of a potentially damaging policy in a critically important area impacting Scotland implemented not only as a result of a Westminster government’s decision but one made through secondary legislation and therefore without recourse to Westminster parliamentary scrutiny. Another example of the quality of Scotland in Union’s democracy!
From the British Medical Journal (April 17, 2026) ‘Opinion: The UK government must publish a detailed impact assessment of the costs and benefits of the US-UK medicines partnership‘.
‘On the eve of the Easter bank holiday weekend, the UK government finally published the full text of its deal with the US government on the prices the NHS will pay for new branded drugs.
‘The central plank of the deal is to waive tariffs on UK pharmaceutical exports to the US in return for the NHS paying 25% more for new branded drugs. The initial mechanism for the latter is an equivalent increase in the National Institute for Health and Care Excellence’s (NICE) standard cost threshold from 1 April 2026, although further price increases may well be needed to meet the scale of extra drug spending the government has signed up to. This revised threshold means that a drug will be considered sufficiently cost effective if for every £35 000 extra it costs above the current standard NHS treatment for the condition, it improves health by at least one quality adjusted life year (QALY). (my emphasis)
‘The government has compelled NICE to raise its threshold by using secondary legislation that has not been subject to parliamentary scrutiny or debate.’
And: ‘The extent to which the economy will be boosted by the deal is unclear because the government has not published an analysis that would allow the assumed benefits of the deal to be examined. What is clear, however, is the substantial opportunity cost that paying more for branded drugs will impose on the health of the UK population. The Department of Health and Social Care’s own analysis estimates that the NHS generates on average one QALY for every additional £15 000 spent on existing services. By committing to pay more than twice that to gain one QALY by using a new branded drug, the government effectively sacrifices 2.3 patient QALYs it could attain by spending the same money on extending existing NHS services.‘
Adding: ‘The commitments to 2036 entail a growth rate on branded drug expenditure four to five times higher than the Office for Budget Responsibility’s estimates for overall health spending growth over the same period.‘
‘.. a curious—yet little publicised—clause in the arrangement is that drug spending won’t just increase in absolute or GDP share terms, but it will also increase as a share of the overall NHS budget. Far from offering reassurance that a higher spend on branded drugs will be afforded by a concomitant increase in tax funding for the NHS, the clause appears to command the opposite.‘
The BMJ piece concludes: ‘The NHS Constitution states that the NHS—and the Secretary of State for Health—is “committed to providing the most effective, fair and sustainable use of finite resources” and to transparency and accountability in achieving this. Yet the terms of the trade deal with the US will clearly reduce the cost effectiveness of the NHS’s finite resources and provide no transparency over (or any accountability for) any broader economic case.
‘Without this information, the public has no way to ascertain if the price paid in health is worth the apparent gains pursued elsewhere.’
No way to ascertain! And neither does Scotland’s government nor voters in Scotland: whilst in this Union, we’re just left waiting, with little agency, on the sidelines until we experience the fall-out for both the size of the (so-called) Block Grant and also the future cost to NHS Scotland of branded drugs. And we need to do so without even Scotland’s MPs having the opportunity in Westminster to exert scrutiny on our behalf!
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