In the Guardian today something we, well stewartb, warned was coming.

The NHS across the UK will have to divert £45bn from essential services to pay for the trade ‘deal’ the UK Labour Government has just done with big pharma in the US.

Scotland’s share, unavoidably as the deal is done by the UK Government alone, will cost NHS Scotland around 8% of that or £360 million.

In April 2026, stewartb, warned this was coming and NHS Scotland would just have to meet the cost from its finite budget unless the UK Government did something.

stewartb

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!

Source: https://www.bmj.com/content/393/bmj.s733