For his next trick, will Donald Trump save the NHS?

The US president, with his threats of punitive tariffs on imported drugs, has injected a degree of urgency into Britain’s national conversation about what it can afford to pay for life-saving drugs – and that’s a good thing, writes James Moore

Donald Trump is once again doing the sort of thing we have come to expect from the US president, railing against the NHS and the amount it pays for medicines. This is now being taken very seriously by prime minister Keir Starmer, who seemingly wants more than anything to claim the friendship of the man in the White House.

The result could be that this country pays billions of pounds more for medicines. This will prove highly controversial in some quarters. But the payoff could be huge.

For it isn’t just Trump who is unhappy about how much Britain pays for its drugs. Big Pharma has long complained about the deal it currently has with the NHS, and the tough criteria imposed by the National Institute for Clinical Excellence (Nice) when it comes to approving new treatments. This is based on how much they cost for each year of ‘good quality life’ they deliver (£20,000 to £30,000 per annum as things stand).

If that sounds cold on the part of Nice, that’s because it is. It is the reason why you sometimes see crowd-funders going up with the aim of raising money to send cancer stricken kids to the US for treatments the NHS won’t pay for.

Consider the following framing: Trump forces NHS to pay billions more to Big Pharma. This is a potentially potent brew for some of Starmer’s critics on the left (Andrew Harnik/Getty Images)

Until recently, the moaning and the wailing and the gnashing of teeth from drug companies has been dismissed in Whitehall. Complain all you want, but the NHS is a big customer. You wouldn’t want to lose it, now would you?

Lately, the mood music has changed, and not just because of Trump. Britain has recently lost out on billions of pounds in investment by drug companies in new labs, research facilities and what have you. The boss of Eli Lilly, maker of ‘fat jab’ Mountjaro, recently branded the UK “probably the worst country in Europe” for drug prices. Merck, another drug giant, called the UK “uninvestable”. There is a growing realisation in government that a world-class industry is being put at risk, leading to a long overdue debate about how best to respond.

Trump, with his threats of punitive tariffs on imported drugs, has injected a degree of urgency into those discussions. And how. Reports now suggest that the PM is going to bow to at least some of the industry’s demands by pumping billions more into medicines. The terms of that debate have changed. The discussions now centre on how much Britain is going to pay and where the money will come from.

Consider the following framing: Trump forces NHS to pay billions more to Big Pharma. This is a potentially potent brew for some of Starmer’s critics on the left. And not just on the left. Consider, too, that AstraZeneca, (Britain’s biggest company by market value), made £6.5bn last year on revenues of £40bn. It paid its CEO Pascal Soirot nearly £15m and delivered something like £3.7bn in dividends to its (mostly) happy shareholders.

Numbers like that are guaranteed to have critics frothing at the mouth about evil fat cats destroying the NHS. Stir in a dose of the Donald and it’s even more explosive.

Here’s what you have to understand before joining the clamour. Drug development is both phenomenally expensive and extraordinarily risky. According to America’s National Library of Medicine, the failure rate when it comes to new treatments is roughly 90 per cent “despite implementation of many successful strategies” aimed at improving this. The failures have as much time and money invested into them as do the successes. Pharmaceutical researchers are highly qualified. They don’t come cheap. They also require fancy labs with fancy kit.

To persuade investors to pony up for this requires that they be rewarded. It’s not as if they don’t have other options when it comes to where to park their cash. However, if Britain and its NHS look at this from an investment perspective, they will also be rewarded. Some of the billions that have recently been withdrawn from this country’s biotech industry may come back. Some of the revolutionary treatments now being tested in other countries - Spain has been particularly successful in this area - may be tested here. Needless to say, that could be very good news if you have a relative with a condition one of those drugs has the potential to zap.

If the end result of Trump demanding money with threats of tariffs held over Britain’s head is this, so much the better. It might even save a life or three.

Sometimes bad people do good things, even if that is not their intention and there are parallels here with the way the US president has handled defence, demanding that Europe pay more to look after itself, reinvigorating NATO in the process. A better defended Europe will have capacity to handle crises like the one in Ukraine without being dependent on the whims of whomever is in the White House. That too, is a good thing.

Of course, Starmer will still have to persuade his chancellor to play ball. But then, he is the prime minister. If Rachel Reeves and the Treasury dig their heels in, there is a treatment available. Not a very pleasant one. It comes with some potentially awkward political side effects, too. But that speaks to the point I’m trying to make. Good things don’t come free.