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For all the crowd noise and heavy-breathing match analysis, British democracy is a simple sport. We elect politicians to serve our interests. They direct the vital services that look after our families and communities, such as our healthcare and our schools. The entire political system rests on one basic premise: they work for us.
Believe that, as I do, and this week is one of vast democratic failure. Rather than working for us, Keir Starmer and his ministers are acting against us. They have rammed through parliament a sweeping law that will, independent experts agree, harm the public; and they have done so without even coming clean on the costs or the consequences. What’s worse, MPs and the press have failed to put this under scrutiny.
One way this has happened is through the use of eye-glazing jargon, to make everything look as dry as possible. So where I can, I shall try to avoid acronyms and technicalities.
In December, Starmer and Donald Trump struck a deal on medicine. Downing Street agreed it would spend more on branded drugs, in return for the White House not jacking up tariffs on British pharmaceutical exports to the US. As I wrote at the time, the treaty stank. One of the greatest achievements of British democracy, our NHS, set up to save lives, had been used to save face with Trump. The most rapacious president in American history now had his hands on our healthcare system.
Wes Streeting and his Department of Health and Social Care gave almost no detail about how much this would cost, or what that meant for patients. They created a black hole of information, then tried their damnedest to present defeat as victory. Look! ministers said: we get to buy these whizzy new drugs from America. Truth was, we always could, if we wanted to – except now the choice was no longer ours.
MPs never got to examine these vast changes. They had no chance to debate the great erosion of our independent system for providing medicine. No awkward backbenchers or querulous lords or scribbling hacks or public information for Starmer and Streeting. Using a statutory instrument, they smuggled the entire thing into law.
Only after the deal came into effect did the government publish even its headline facts and figures, sneaking them out just before the Easter bank holiday. Only this week did MPs finally get the chance to debate the changes, “long after the horse has bolted”, as Labour backbencher Rachael Maskell told me. And this morning we got the first detailed analysis of the cost for you, me and our NHS. The analysis has been conducted by three senior health researchers, including a former senior adviser to the National Institute for Health and Care Excellence (Nice), the body that sets how much we pay for our medicines. Published in the British Medical Journal, it suggests the public has been misled on an epic scale.
When discussing the deal with Trump, Streeting made voters three promises. First, in any negotiation, “the NHS is not on the table”. Second, “we’re not going to cut NHS services to fund the pharma deal”. And finally, over the next couple of years the agreement would cost “around £1bn” a year. All three of these pledges now look utterly false.
In the face of Trump’s bullying, the government will double how much it spends on drugs as a share of national income, going from 0.3% now to 0.6% in a decade. It also accepts that the money will come from the NHS budget. The BMJ analysis suggests that over the next couple of years the NHS will have to find almost three times the amount pledged by Streeting. By the end of the decade, the authors believe, the cost will be a total £44.7bn. For perspective, this week’s headlines have been dominated by a plan that will require the government to find an extra £15bn for defence. The NHS may have to find triple that just to pay for drugs, thanks to a deal fronted by its own health secretary.
That extra money will go from British taxpayers to shareholders in multinational drug companies. And working on the basis that it will come from the NHS budget, the study shows it will cause a massive loss of life. More money for branded pharmaceuticals means less for cancer scans or doctors and nurses, statins and diabetes drugs. Using many years of data on the links between NHS spending and patient health, the authors’ model forecasts that this will cause an extra 229,000 deaths by 2036. The academics describe this as a “conservative” estimate, but it is getting on for double the avoidable deaths Britain suffered during the Covid pandemic. You might call this a massacre made in Whitehall, at the behest of Trump’s White House, in order to buff up shareholder returns.
After the pandemic, Starmer and Streeting rightly led the charge in calling for lessons to be learned. The government was forced to launch an inquiry. Here is a trade deal that looks more lethal than Covid, yet which has been subject to almost zero democratic scrutiny. The Department of Health and Social Care told me it does not recognise these figures, but despite many requests from MPs and others, it has not published its own impact assessment. Indeed, the basics of parliamentary democracy have failed. No inquiry by the select committees working on health or trade or science. No Commons debate until this week, at which a junior minister was put up to catch the flak and was told by one MP that “everything [she] is saying is in the press release”. As for the media, there has been something close to silence. Over the past six months, according to the Guardian’s research and information department, the national newspapers published a grand total of eight stories on this deal that will change the face of our NHS; at the same time they did, however, find space for 274 stories on whether Wes Streeting would become the next Labour leader. One man’s career prospects deserve more airtime than the lives of our elderly, ill and poor people.
Soon, the UK will have a new prime minister, one who promised this week more democracy, more accountability, greater transparency. So here’s a test for Andy Burnham: is he really going to let this fatal deal, cooked up in private and shrouded in unforgivable secrecy, stand?
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