Nuffield Trust Senior Policy Analyst Sally Gainsbury has served a Notice of Appeal asking the Information Rights Tribunal to review the Information Commissioner’s decision to allow the government to withhold its impact assessment of the December 2025 pharmaceutical trade deal with the US.
The trust has expressed support for her action. In a blog post published on the trust website, Thea Stein has said that there is "considerable public interest in transparency around the evidence, assumptions and forecasts that informed the deal.
"This includes the assumptions the government made about the anticipated effect that significantly higher spending on branded new medicines would have on the health service, as well as the assumed impact of the deal on the wider UK economy."
She said that the Nuffield Trust has been trying to obtain the assessment through a Freedom of Information Act (FOIA) request to the Department of Health and Social Care (DHSC) – "a process which included an internal review and a referral to the Information Commissioner."
According to her, Nuffield Trust believes that the potential implications of the UK–US deal present a real risk to the health of the people of the United Kingdom.
She said that by declining to disclose the information, the DHSC has to date referred to a series of exemptions to the FOIA, "most notably an exemption designed to preserve a “safe space” for ministers and civil servants to consider policy options in private."
Stein said that as per FOIA when the safe space exemption is invoked, the public benefit (or “interest”) in withholding information must be weighed against the public benefit of disclosing it.
"In this case – a deal which commits the UK to double the share of GDP spent on new branded medicines – we believe the public interest weighs in favour of transparency. When the ICO reviewed the case in July, it found in the department’s favour, but described the matter as “relatively finely balanced”. That is a decision we are now asking the Information Tribunal to review."
Stein said this is a case about transparency in decisions around allocating resources within NHS, and "how much of its core purpose – health improvement for the population – we are prepared to set aside or trade off for other goals, such as economic growth."
"A decision to increase how much the health service spends on one form of health care inevitably limits what it is able to spend on others."
Citing economic analysis she said that the NHS can generate around one quality-adjusted life year (QALY) for every £15,000 extra it spends on existing health care services (such as GP or hospital care).
"However, under the terms of the trade deal, the NHS will be required to pay up to £35,000 per QALY for new drugs and to increase the overall share of its budget spent on these.
"This means the NHS will be able to secure fewer QALYs for the population as a whole from its finite budget."
She said the government may believe that despite the apparent costs to population health, the deal represents good value for the public.
"But neither our elected politicians nor the general public have been given the opportunity to understand how such purported costs and benefits stack up, nor to scrutinise whether the assumptions made in estimating them are sound."
