The UK's National Health Service could be forced to divert billions of pounds from essential services to pay for new medicines, a move that an analysis by a doctors’ union has linked to 229,000 excess deaths. The cause is the US-UK trade deal agreed in December 2025, which critics say prioritises appeasing Donald Trump over protecting the NHS. Ministers defend the deal as a way to help British drug exports avoid US tariffs and give patients access to vital medication, but the cost to the health service has sparked fierce debate.
At its core, the US-UK trade deal includes provisions that require the NHS to pay more for new pharmaceutical products. According to a doctors’ union analysis, this will divert around £45bn from essential NHS services. The union further calculates that this diversion could lead to 229,000 potentially preventable deaths – a figure hotly disputed by the government. The Labour government, which signed the deal in December 2025, has been accused of caving in to pressure from former US President Donald Trump, who had long argued that the UK should pay more for American drugs.
“How a US-UK trade deal could divert £45bn from NHS services and lead to 229,000 excess deaths.”
The background to this controversy lies in the decades-long relationship between the NHS and the pharmaceutical industry. The NHS has historically used its collective purchasing power to negotiate lower drug prices, a system that US administrations have often criticised as unfair. During the Trump presidency, the US pushed for higher payments in any trade deal. The December 2025 agreement is the culmination of those efforts, with the UK accepting higher drug costs in exchange for favourable treatment for British pharmaceutical exports to the US.
For UK readers, the practical impact is stark. The £45bn diverted from essential services means less money for hospitals, GP surgeries, mental health care, and community services. While the government insists patients will still get the medicines they need, the doctors’ union argues that the knock-on effect will be worse health outcomes overall. The 229,000 excess deaths figure is presented as the likely consequence of reduced NHS capacity and delayed treatments. Even if the exact number is disputed, the scale of the financial shift is unprecedented in NHS history. #### Key questions answered
Q: How much extra will the NHS have to pay for medicines under the deal? According to a doctors’ union analysis, the deal will force the NHS to divert around £45bn from essential services to cover higher drug costs. The government has not confirmed this figure but has not denied it either.
Q: Why does the US want the UK to pay more for drugs? US administrations, particularly under Donald Trump, have long argued that the NHS underpays for American-made pharmaceuticals. The trade deal is designed to increase UK payments in exchange for better access to the US market for British drug exporters.
Q: Will patients notice any immediate changes? In the short term, patients may not see direct changes, but the diversion of billions from other services could lead to longer waiting times, reduced staff, and cuts to non-drug treatments. The doctors’ union warns that the cumulative effect could be thousands of excess deaths.
#### What happens next The £45bn diversion and the 229,000 excess deaths claim will be intensely debated as the deal takes effect. The Labour government continues to defend the agreement, but critics are calling for a renegotiation. The full impact on NHS services will become clearer as the first years of the deal unfold, with the doctors’ union pledging to monitor and publicise the consequences.