An analysis published in The BMJ on 1 July 2026 has laid bare the human cost of the UK-US pharmaceuticals deal agreed last December. Without additional money for the NHS, the arrangement will require an extra £44.7 billion spent on branded medicines by the end of 2036. That spending, the researchers calculate, will displace care elsewhere and result in around 229,000 excess deaths in England alone.
The figures come from Samuel Cross, Karl Claxton and Andrew Hill. Their paper applies standard NHS opportunity-cost methods used by NICE. The authors are blunt.
Even if we restrict attention to the direct effect of reductions in available NHS expenditure, by 2036 this deal is likely to result in roughly 229,000 excess deaths – more than during the COVID-19 pandemic between March 2020 and June 2022 (137,000).
The deal commits Britain to raising the share of GDP devoted to new medicines from 0.3 percent to at least 0.6 percent by 2036, with milestones at 0.35 percent in 2028 and 0.4 percent in 2030. It offers a three-year zero-tariff window for UK pharmaceutical and medical device exports to the United States. In return it loosens domestic pricing controls and lifts the NICE cost-effectiveness threshold from £20,000–£30,000 to £25,000–£35,000 per QALY.
Those changes matter. Higher prices for branded drugs, without a corresponding increase in the overall NHS budget, mean less money for every other part of the service. The largest rises in mortality are projected in cardiovascular disease, respiratory illness, gastrointestinal conditions and cancer. When indirect effects on adult social care are included the total climbs to 291,000 excess deaths by 2036.
Calls for withdrawal intensify
A follow-up report in The BMJ on 16 July revealed growing pressure on the incoming government. MPs and health experts have urged Andy Burnham, who is due to become prime minister around 20 July following Keir Starmer’s resignation, to abandon the agreement.
At a parliamentary event on 13 July hosted by John McDonnell, Sally Gainsbury of the Nuffield Trust warned that the research should give Burnham pause. She noted his stated priority of economic growth. The event also heard John McDonnell condemn the previous government’s refusal to publish an impact assessment. He called the omission outrageous and undemocratic, demanding the assessment be released, scrutinised and the policy reversed.
