Department of Health and Social Care

Iqbal Mohamed Excerpts

Tuesday 30th June 2026 Commons Chamber

[Iqbal Mohamed (Dewsbury and Batley) (Ind)]

An estimated 229,000 excess deaths by 2036—that is the eye-watering figure that BMJ analysis identifies as the upshot of diverting NHS funding to pay more for pharmaceuticals in response to Trump’s threats.

Estimates day debates exist to scrutinise how public money will be spent before that spending has happened, not least when the decisions could have such damaging consequences for the health of our nation. This estimates day debate does not include the full budgetary consequences of the UK-US pharmaceutical deal agreed on 1 December. When we look at the cost, the Government’s figures simply do not stack up. Instead, we see a structural weakening of NHS safeguards on drug pricing, higher thresholds, weaker rebate mechanisms and a commitment to dramatically increase spending, which will prove devastating for patient health.

Ministers claim that the arrangement will cost about £1 billion over the current spending review period, but independent analysis tells a different story. Using the projections of the Office for Budget Responsibility, the House of Commons Library suggests that increasing spending on medicines in line with the Government’s commitments would require about £1.7 billion extra by 2028, and potentially as much as £14 billion a year by 2036.

The Government have been clear on one point, and one point only: they say that those increased costs will come from existing NHS budgets. No new funding has been guaranteed. Every extra billion spent on higher-priced medicines is a billion not spent elsewhere in a system that is already under immense strain. This is money not spent on tackling waiting lists, not spent on primary care, and not spent on saving lives. As we have heard, the Nuffield Trust has made that point starkly, estimating that the NHS will be able to save 340,000 fewer years of quality-adjusted life in 2035 if the promised spending goes ahead.

Despite the magnitude of these changes, the Government have refused to publish the full impact assessment of the deal that they hold. Why? This worrying development can be seen in the way in which the UK-US pharma deal was forced through, with no vote and scant parliamentary oversight. Let me summarise what I wrote on PoliticsHome back in March. This deal will increase the cost-effectiveness threshold set by the National Institute for Health and Care Excellence, curtail the overall cost cap on patented medicines, double the amount spent on such medicines, and increase the share of the NHS budget allocated to medicines. That should worry every Member of this House, because once those safeguards have been eroded, they are very difficult to restore.

[Sadik Al-Hassan (North Somerset) (Lab)]

I must declare an interest as a registered pharmacist for nearly two decades and an expert on pharmacy procurement.

Let be begin by saying that I welcome the UK-US pharmaceutical trade agreement, and also by saying something quite controversial: President Donald Trump is right. We do underpay for drugs—not just our expensive, lifesaving rare cancer drugs, but the everyday drugs that we purchase.

[Iqbal Mohamed]

Will the hon. Gentleman to comment on the fact that the NHS pays 10 times the manufacturing costs for over 80% of the licensed medicines that we buy? How is that underpaying?

[Sadik Al-Hassan]

I am not sure where the hon. Gentleman’s figures come from. When we look at the drug tariff reimbursement, which is the system that we use to pay, and compare it with the arrangements in other countries, it is clear that we underpay significantly. Perhaps he is referring to something of which I am unaware; I should be happy to chat to him outside.

We in this country are addicted to low-cost drugs for our health service, and what does that addiction mean? It means that we have the lowest costs and we always go for the cheapest drugs, and that favours foreign manufacturers. It destroys UK supply chains, as we have seen over the last 25 years, and it endangers our resilience as a country. We are already seeing the side effects of that, with drugs being out of stock. We have a system for payment called the drug tariff, which establishes how much pharmacies will buy drugs for and how much they will be reimbursed for. There are currently 254 price concessions. Price concessions happen when a drug is out of stock, and we must make an emergency increase to the price in the drug tariff to try to bring it back into the country. Given that there are 3,500 drugs in that section of the drug tariff, 254 does not sound a lot, but it is the highest level that I remember seeing in my entire professional career. Last month’s highest level of 230 has just been exceeded.

Cheap drugs often mean that we overvalue the benefit of medicines in our system and use a “drug first” approach in the NHS, and that has continued for decades. When we increase the price that we pay for drugs, it allows us to start considering the benefits of other types of treatment, such as social prescribing. Social prescribing becomes a great deal cheaper by comparison in a system in which drugs are valued at the correct level. The all-party parliamentary group on pharmacy, which I chair, published a report in June 2025 that laid out some of the problems with drug pricing and availability. I absolutely support the idea of paying more for drugs, because at the moment we are building a system that is creaking and breaking. By trying to pursue every penny of savings, we have destroyed UK manufacturing and offshored our problems. The only way to bring that back is to rebuild the drug tariff, with the idea of paying to procure more in the UK.