When the NHS celebrated its 75th anniversary last week, it prompted a fresh debate about a healthcare system on the brink of collapse.
Prof Philip Banfield, the chair of the council of the British Medical Association, warned the union’s annual meeting in Liverpool that every indicator in the NHS was “flashing red”. A chief executive at an acute NHS trust said they felt the health service was “locked in a death spiral”, with trusts struggling with staff and inadequate resources in the face of mounting pressure.
But amid record demand and calls for greater investment, an investigation by the Observer has found there is one source of funds for the NHS which appears to be booming: Big Pharma cash. Transparency data on pharmaceutical industry finances reveals a sharp rise in spending by drug firms in the UK health sector.
The records include more than 300,000 payments to healthcare organisations and professionals over the past eight years, including donations, partnership deals, consultancy fees, payments for contracted services and expensesacross the NHS and private firms.
They show that, in 2022, the total value of such payments was more than £200m – up 26% compared with the previous year, and almost double the amount spent by industry in 2015.
The payments in the database published by the Association of the British Pharmaceutical Industry (ABPI) reveal how drug company money is flowing through every part of the healthcare system, from hospital clinics to GP practices to clinicians helping to shape future treatments. They include thousands of payments to NHS organisations and staff.
Pharmaceutical companies are targeting one of the biggest markets in the world. The total expenditure in England on medicines and devices in the NHS in 2020-21 was estimated to be £17.8bn. Among the biggest spenders last year were the makers of blockbuster drugs for diseases linked to obesity, including type 2 diabetes and cardiovascular disease.
David Rowland, director of the Centre for Health and the Public Interest, said the rise in industry funding raised concerns about conflicts of interest – and questions for NHS leaders. “Who is monitoring this at both national and local level?” he said. “And what do patients know about these deals? Would they be comfortable knowing that Big Pharma was funding their care potentially to increase the use of one of their drugs?”
The NHS has, for years, partnered with private companies to enable critical research that has led to life-saving treatments for everything from cancer to Covid. The Disclosure UK database sheds light on spending of a different nature. It excludes research and development and instead records payments for sponsorship, donations and joint projects – many of which are linked to the promotion of drugs by pharmaceutical firms.
The NHS funding – worth £29.5m in 2022, up from £22.6m in 2021 – includes industry-financed initiatives to “bust” NHS waiting lists and joint projects to redesign treatment pathways across services for diabetes, obesity, multiple sclerosis, cancer, severe asthma and rare diseases.
The collaborations aim to boost access to NHS treatment and improve patient care, according to project documents seen by the Observer. There are also significant potential benefits for the companies.
One partnership, between Novartis and University Hospitals Birmingham NHS foundation trust, aims to expand multiple sclerosis services. A project document says this involves the recruitment of an MS pharmacist to support the trust, which will help “address the staff shortages” and “tackle the backlog of patients”. There are also potential benefits for Novartis through “optimal use of medicines in appropriate patients”, the document adds.
Other partnerships aim to overhaul treatment pathways for obesity, diabetes, asthma and cancer.
In another example, drug company Boehringer Ingelheim – a manufacturer of heart failure drugs – was handed a key role in helping train NHS clinicians. In a partnership with NHS England it is helping to provide training to cardiac clinical leaders to “support the transformation of cardiac services”, according to a document on its website. Payment logs show the company gave NHS England support worth £80,000 for the joint project.
NHS England said such collaborations with industry helped patients “benefit from faster access to innovative treatments” and that safeguards were in place. The ABPI said they could deliver “huge benefits” for patients and were governed by a strict industry code.
But in some cases, the decision by industry to partner with the NHS at a time when it is under great pressure appears part of a strategy to boost sales. In a brochure for drug company clients, one consultancy firm is explicit about the potential benefits. “In an environment blighted by waiting lists, ‘capacity busting’ programmes may represent the single biggest opportunity for companies to increase sales quickly,” it says.
Beyond direct NHS collaborations, drugs firms are making thousands of payments to GP practices and private companies that support NHS care. These are likely to include support to clinics for certain treatments, however the purposes of the payments are not published in the Disclosure UK database.
More than £43m was also paid to healthcare individuals in 2022, an increase of 27% compared with the previous year, according to the disclosure records. These payments are across the health sector, with fees paid to senior consultants involved in research, hospital doctors, GPs, nurses and pharmacists.The Observer has found, in some cases, money has been paid to GPs acting as regional clinical leads in the NHS for some of the most prevalent diseases.
One of the largest recipients of money from the industry in 2022 was a Northampton GP, Dr Yassir Javaid, who was paid £132,390 in fees and expenses by various drug firms in 2022. Since 2019, the industry database shows that he has been paid £483,561 by the pharmaceutical industry, including fees from Bayer, Pfizer, AstraZeneca and Eli Lilly.
Javaid, who was a regional clinical lead for Northamptonshire Integrated Care System until last month, has spoken at events sponsored by drug firms to promote a class of diabetes drugs known as SGLT2 inhibitors which can lower blood sugar and can reduce the risk of cardiovascular death. One of his presentations in October 2019 funded by Boehringer Ingelheim and Eli Lilly described one of its objectives to “consider the unmet clinical need” and the use of the diabetes drug Jardiance to improve outcomes.
He said this weekend he was committed to transparency; had always opted in to voluntary disclosures on Disclosure UK; and had always correctly disclosed his interests. He said his sponsored educational sessions promoted evidence based and guideline recommended use of treatments.
Naresh Kanumilli, another GP who is the clinical lead for diabetes for NHS England in the north-west, has also received significant funding from drug companies, according to the database. He has supported AstraZeneca in developing educational resources. He received £45,044 in fees and expenses last year. Between 2019 and 2022, he has received £220,074.
The NHS said Kanumilli had correctly disclosed his interest, had promoted a healthier lifestyle for the prevention of diabetes and was not involved in recommending specific drugs. His consultancy work is balanced with clinical commitments, and includes supporting global education strategies, said an official.
Dr Jim Moore, a GP in Cheltenham in Gloucestershire, who is president of the Primary Care Cardiovascular Society and a clinical lead for the NHS England West of England integrated cardiac clinical network, was paid £15,353 by the drug firms last year in fees and expenses.
He has been paid £112,568 between 2019 and 2022. A spokesperson for NHS England in the south-west said: “Dr Moore plays an essential role in improving cardiac care in the south west. He’s always been totally transparent about his other roles and his earnings from industry, as set out on the Disclosures website.”
The findings have led to concern among health professionals and experts in conflicts of interest in medicine. The drugs companies, including Bayer, Pfizer, Novartis, GSK, AstraZeneca, Eli Lilly and Boehringer Ingelheim, said they supported transparency and complied with the strict industry code. They said their partnerships in the health sector were crucial to advancing healthcare and were in the interests of patients. The ABPI said: “Collaborative projects benefit patients and the healthcare system and they are governed by the industry’s strict code of practice, which goes above and beyond the law.”
But Dr David Unwin, who has championed a low-carb lifestyle that has been shown to reverse type 2 diabetes, said drug industry funding risked distorting treatment. “With so many drug companies paying to advance the pharma agenda, there is an obvious imbalance. No one is pushing the lifestyle agenda and, over time, this is distorting medical practice to an alarming degree.”
Details of the NHS partnerships have also sparked concerns about transparency. The partnerships came to light through analysis of the spending records, cross-referenced with disclosures on the companies’ websites. But in many cases the industry tie-ups were not being announced by the NHS trusts themselves – meaning many patients are unlikely to know they exist.
Dr Margaret McCartney, a GP who has studied conflicts of interest in medicine, said the involvement of drug companies in NHS treatment services raised concerns about undue influence behind the scenes. “If you let the drug companies come in, they will shape services and priorities according to what they see the priorities as being,” she said.
Professor Dee Mangin, a professor of general practice and family medicine at University of Otago, said the findings underlined the influence of the pharmaceutical industry over the supply chain – “from research to delivery of drugs”. “All drugs have side effects and this drives more sales,” she said. “It is naive to consider this is in the best interest of the NHS.”
Additional reporting: Nneoma Ekwegh
