The UK National Health Service (NHS) faces a potential £45 billion shortfall by 2036 due to higher drug costs stemming from the UK-US trade deal signed in December 2025, according to a recent analysis published in the British Medical Journal. The diverted funds, equivalent to billions annually, could come at the expense of essential health services, leading to significant adverse outcomes, including an estimated 229,000 excess deaths in England.

The analysis, conducted by researchers from the University of York, the University of Liverpool, and Christchurch Hospital in New Zealand, highlights the financial strain on the NHS resulting from commitments in the trade agreement. The deal requires the NHS to pay approximately 25% more for new medicines over the next decade. Currently, the NHS allocates around £14.4 billion annually for innovative therapies, which is projected to double as a share of GDP—from 0.3% to 0.6%—by 2036 under the deal's terms.

Experts warn that this increase in drug spending will likely force cuts to other vital NHS services, such as preventive care, community health programs, and treatment for chronic conditions. The researchers estimate that these cuts could produce a death toll exceeding the 137,000 attributed to the COVID-19 pandemic between March 2020 and June 2022. Including the impact on adult social care, the excess death estimate rises to nearly 291,000. Most preventable deaths would affect patients with heart, respiratory, gastrointestinal diseases, or cancer.

The UK government has defended the trade pact, emphasizing its role in eliminating tariffs on British drug exports to the United States that were previously threatened, potentially by as much as 100%. Officials have described the agreement as a “landmark” step toward safeguarding access to medicines and encouraging investment in UK pharmaceuticals. They argue the deal benefits British manufacturers by securing tariff-free access to the US market.

However, opposition parties, campaign groups, and health experts have expressed skepticism about the deal’s impact on the NHS. Campaigners accuse the government of yielding to US demands—particularly those associated with former President Donald Trump—to increase drug prices to the NHS, thereby prioritizing pharmaceutical profits over public health. Several MPs have called for the government to release its own impact assessment, which has so far not been made public.

The Department of Health and Social Care disputes the analysis’s figures. A spokesperson stated that the £45 billion figure is not recognized and pointed out that funding for the NHS will be determined as part of ongoing spending reviews, which have already secured record levels of investment for the health service.

Patrick Vallance, the science minister, previously acknowledged the rising costs resulting from the deal would be covered by the Department of Health and Social Care rather than the Treasury. The new study estimates the annual additional cost to the NHS could reach £8.8 billion by 2036, cumulatively amounting to £44.7 billion over the period.

Health officials and patient advocacy groups have voiced serious concerns over the trade agreement. Sir Ciarán Devane, chief executive of the NHS Alliance, emphasized the potential consequences of shifting billions from frontline care to pharmaceutical expenses, warning of profound effects on prevention and long-term condition management. Liberal Democrat health spokesperson Helen Morgan described the situation as “alarming,” urging the government to publish a full impact review.

Campaigners, including those from Global Justice Now and the patient group Just Treatment, have criticised the deal for prioritizing pharmaceutical companies’ profits over patient care, condemning the lack of parliamentary scrutiny during negotiations. They have called on future government leadership to reassess and potentially reverse the provisions of the agreement to protect the NHS’s sustainability and patient welfare.