As the NHS celebrated its 75th anniversary last week, it sparked fresh debate over a healthcare system teetering on the brink of collapse.
British Medical Association Council leader Prof Philip Banfield warned at the union’s annual meeting in Liverpool that all indicators in the NHS were “flashing red”. A chief executive of an NHS acute care trust fund said he felt the healthcare system was “caught in a death spiral” as trusts struggled with staffing and insufficient resources amid mounting pressures.
But amid record demand and calls for larger investments, an investigation into the observer has found there is one source of funding for the NHS that appears to be booming: cash from Big Pharma. Transparency data on the finances of the pharmaceutical industry shows a sharp increase in spending by pharmaceutical companies in the UK healthcare sector.
The records include more than 300,000 payments made to healthcare organizations and professionals over the last eight years, including donations, partnership deals, consultancy fees, payments for contracted services and expenses across the NHS and to private companies.
They show that the total value of such payments was more than £200m in 2022 – a 26% increase on the previous year and almost double the amount the industry spent in 2015.
Payments in the database released by the Association of the British Pharmaceutical Industry (ABPI) show how money from pharmaceutical companies flows through every part of the healthcare system, from hospital clinics to GP surgeries and clinicians involved in shaping future treatments. That includes thousands of payments to NHS organizations and staff.
Pharmaceutical companies are targeting one of the largest markets in the world. Total spending in England on medicines and devices in the NHS in 2020-21 has been estimated at £17.8 billion. Among the biggest funders last year were the makers of blockbuster drugs targeting obesity-related diseases, including type 2 diabetes and cardiovascular disease.
David Rowland, director of the Center for Health and the Public Interest, said the surge in industry funding has raised concerns about conflicts of interest – and questions for NHS leaders. “Who is monitoring this at the national and local levels?” he said. “And what do patients know about these offers? Would they be reassured to know that Big Pharma might be funding their treatment to increase the use of one of their drugs?”
The NHS has worked with private companies for years to facilitate important research that has led to life-saving treatments for everything from cancer to Covid. Disclosure UK’s database shows other types of spending. It does not include research and development, but instead records payments for sponsorships, donations and collaborative projects – many of which are related to drug promotion by pharmaceutical companies.
NHS funding – worth £29.5m in 2022, up from £22.6m in 2021 – includes industry-funded initiatives to ‘lock down’ NHS waiting lists and collaborative projects to redesign treatment pathways in all services for diabetes, obesity, multiple sclerosis, cancer, severe asthma and rare diseases.
The collaborations aim to improve access to NHS treatment and improve patient care, say project documents seen by the NHS observer. There are also significant potential benefits for companies.
A partnership between Novartis and University Hospitals Birmingham NHS Foundation Trust aims to expand multiple sclerosis services. A project document says this includes hiring an MS pharmacist to support the Trust, which will help “solve staffing shortages” and “manage the patient backlog”. The document adds that Novartis also has potential benefits from “optimal use of medicines in appropriate patients.”
Other partnerships aim to revamp the way we treat obesity, diabetes, asthma and cancer.
In another example, pharmaceutical company Boehringer Ingelheim – a maker of heart failure medicines – has been given a key role in training NHS doctors. In a partnership with NHS England, the company is helping train cardiology leaders to “support the transformation of cardiology services,” according to a document on its website. Payment logs show the company has given £80,000 in support to the joint project, NHS England.
NHS England said such industry collaborations had helped patients “benefit from faster access to innovative treatments” and that safeguards were in place. The ABPI said they could offer “tremendous benefits” to patients and are subject to a strict industry code.
But in some cases industry’s decision to work with the NHS at a time when it is under a lot of pressure appears to be part of a strategy to increase sales. In a brochure for customers of pharmaceutical companies, a consulting firm explicitly addresses the potential benefits. “In an environment characterized by waitlists, capacity reduction programs can represent the greatest opportunity for companies to rapidly increase sales,” it said.
In addition to direct NHS cooperation, pharmaceutical companies make thousands of payments to GP practices and private companies that support NHS care. This is likely to include supporting clinics for specific treatments, but the purposes of the payments are not disclosed in Disclosure UK’s database.
According to disclosure documents, more than £43m was also paid out to healthcare individuals in 2022, a 27% increase on the previous year. These payments are made across the healthcare sector and are paid to senior research consultants, clinicians, general practitioners, nurses and pharmacists observer has found that in some cases money has been paid to GPs who act as regional clinical directors in the NHS for some of the most common diseases.
One of the biggest recipients of industry funds in 2022 was a Northampton GP, Dr. Yasser Javaid, who received £132,390 in fees and expenses from various pharmaceutical companies in 2022. As of 2019, the industry database shows he has received £483,561 from the pharmaceutical industry, including fees from Bayer, Pfizer, AstraZeneca and Eli Lilly.
Javaid, who was regional clinical leader for the Northamptonshire Integrated Care System until last month, has been speaking at events sponsored by pharmaceutical companies to promote a class of diabetes drugs known as SGLT2 inhibitors, which lower blood sugar and reduce the risk of one reduce cardiovascular death. In one of his presentations in October 2019, funded by Boehringer Ingelheim and Eli Lilly, he described one of his goals as “addressing unmet clinical needs” and using the diabetes drug Jardiance to improve outcomes.
He said this weekend he is committed to transparency; had always opted for voluntary disclosures at Disclosure UK; and had always disclosed his interests correctly. He said his sponsored training sessions promoted evidence-based and guideline-recommended use of treatments.
Naresh Kanumilli, another GP who is becoming 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 assisted AstraZeneca in developing educational resources. Last year he received £45,044 in fees and expenses. Between 2019 and 2022 he has received £220,074.
The NHS said Kanumilli correctly expressed its interest, promoting a healthier lifestyle to prevent diabetes and was not involved in recommending any specific medicines. His advisory work is consistent with clinical commitments and includes support for global education strategies, an official said.
dr Jim Moore, a GP at Cheltenham in Gloucestershire, President of the Primary Care Cardiocular Society and Clinical Director of the NHS England West of England Integrated Cardiology Clinical Network, received £15,353 in fees and expenses from the drug companies last year.
Between 2019 and 2022 he received £112,568. A spokesman for NHS England in the South West said: “Dr. Moore plays an integral role in improving heart care in the Southwest. He has always been fully transparent about his other responsibilities and his earnings from the industry as set out on the Disclosures website.”
The results have raised concerns among healthcare professionals and experts on conflicts of interest in medicine. The pharmaceutical companies, including Bayer, Pfizer, Novartis, GSK, AstraZeneca, Eli Lilly and Boehringer Ingelheim, said they supported transparency and adhered to the strict industry code. They said their partnerships in the healthcare sector are vital to the advancement of healthcare and are in the interests of patients. The ABPI said: “Collaborative projects benefit patients and the healthcare system and are subject to the industry’s strict codes of conduct, which go beyond the law.”
But dr David Unwin, who advocates for a low-carb lifestyle that has been shown to reverse type 2 diabetes, said funding from the pharmaceutical industry ran the risk of distorting treatment. “With so many pharma companies paying to push the pharma agenda, there is obviously an imbalance. No one drives the lifestyle agenda and over time, this distorts medical practice to an alarming degree.”
Details of the NHS partnerships have also raised concerns about transparency. The partnerships came to light through an analysis of spending records, which were cross-checked with disclosures on the companies’ websites. But in many cases, the industry collaborations have not been announced by the NHS trusts themselves – meaning many patients are unlikely to know they exist.
dr Margaret McCartney, a GP who has researched conflicts of interest in medicine, said the involvement of pharmaceutical companies in NHS treatment services raises concerns about undue influence behind the scenes. “If you let the drug companies in, they will shape their services and priorities as they see fit,” she said.
Professor Dee Mangin, professor of general and family medicine at the University of Otago, said the findings underscore the pharmaceutical industry’s influence on the supply chain – “from research to the delivery of medicines”. “All drugs have side effects and that increases sales,” she said. “It is naïve to think that this is in the best interests of the NHS.”
Additional Reporting: Nneoma Ekwegh