Nuffield Trust warns UK-US medicines deal could cut 10,000 NHS jobs by 2028

A deal signed by Sir Keir Starmer with Donald Trump to protect UK drug exports from US tariffs could leave the NHS with at least 10,000 fewer jobs by 2028, according to analysis by the Nuffield Trust.

The think tank's work, shared with reporters, suggests that because the government has said it will not raise NHS funding to pay for the deal, around two-thirds of the extra cost would have to come from the NHS pay bill. That would mean at least 10,000 fewer jobs across the health service by 2028 than would otherwise be expected, from senior consultants to hospital estates staff.

The UK-US pharma deal was signed last year. It commits the UK to spend more on American medicines in return for zero tariffs on UK drug exports for three years and better access to cutting-edge drugs. But the Nuffield Trust has questioned the value of the agreement. It notes the deal was signed when the US administration was threatening 100% tariffs; a few months later, the Supreme Court ruled those tariffs could only be 10%. Economists are asking whether the UK signed a deal that will cost the NHS £12 billion a year in real terms by 2036 to avoid tariffs that were never going to happen.

There are also concerns about drug access. The HIV drug Lenacapavir was launched with excitement because the six-monthly injection gives close to 100% protection against the virus. It is not available in the UK because it is too expensive. Gilead charges $28,000 a year for a drug that costs $40 a year to make. NICE has said the NHS cannot afford it. With no agreement, no one is being treated and the epidemic continues to grow. Gilead Sciences said it is still engaging over potential pathways to support future access.

The deal changed the way the NHS values medicines. Under it, NICE increased the amount the NHS will pay for every extra year of good quality life a medication can give by 25%. The government also committed to doubling its spend on new medicines to 0.6% of GDP.

Scrutiny of the deal is increasing. There was no parliamentary debate before it was signed, and the government's impact assessment has never been published. The Nuffield Trust is appealing a decision not to release the assessment under the Freedom of Information Act. Six chairs of parliamentary committees have formally asked the National Audit Office to carry out a rapid investigation. It is also understood that the Office for Budget Responsibility is looking at whether the deal could harm the public finances.

The Department of Health and Social Care did not answer questions about why it will not publish the risk assessment. It said the deal would give access to more life-changing medicines and support investment, jobs and growth in the life sciences sector. It added that nine additional medicines, including a new breast cancer drug, have since been approved. Without scrutiny of the deal, it remains unclear what price the NHS, patients and staff will pay for those new drugs.