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The row between “big pharma” company Novartis, the government, and the NHS over the cost of new drugs is not just another “technical” disagreement about rebates and thresholds.

It is a test of who really runs Britain’s health system: elected representatives acting in the public interest, or multinational corporations prepared to hold patients hostage to profit.

Novartis has claimed that NHS patients will “lose access” to life-saving medicines unless ministers back down on a current drug pricing deal. That is not a warning – it is a threat.

By refusing to launch treatments here while selling them in France and Germany, companies are weaponising sick people’s desperation as a bargaining chip in negotiations. It’s blackmail, pure and simple.

The government, for its part, has allowed itself to get into this position by sticking with outdated systems and refusing to confront industry power head-on:

NICE, the body that decides whether a medicine is good value for money, has been using the same cost-effectiveness thresholds since 1999. Inflation, medical advances and social priorities have all moved on – but the rules have not. This stagnation has created the perfect excuse for pharmaceutical giants to paint Britain as “uninvestable” while quietly lobbying for higher profits.

Meanwhile, ministers boast about “generous offers” to industry – even as rebate rates are watered down and billions that should strengthen the NHS are used to sweeten deals for drug companies. The Health Secretary, Wes Streeting, talks about not letting firms “rip off” the taxpayer, but so far the balance of power suggests the opposite: the government is being pushed into a corner, trying to appease an industry that knows how to play hardball.

There is a better way.

Patients should not be denied medicines, but nor should corporations be allowed to dictate public health policy. The government must stop pretending this is a zero-sum game between affordability and access. It can:

• Reform NICE’s thresholds transparently, so decisions reflect today’s realities rather than numbers frozen a quarter of a century ago.

• Use Britain’s bargaining power, working with European neighbours to demand fairer prices rather than letting companies pick countries off one by one.

• Be prepared to use compulsory licensing, forcing cheaper versions of drugs onto the market if corporations withhold them.

• Invest in public research and manufacturing, so the NHS is not permanently dependent on multinationals for every new treatment.

If ministers refuse to act, they will have surrendered the principle that the NHS exists to serve patients, not shareholders.

Big Pharma’s tactics show exactly why democratic control of healthcare is essential.

The NHS cannot afford – and the public should not tolerate – a system where multinational companies decide who lives and who dies based on profit margins.

The choice is stark: stand up to blackmail, or give in and make Britain a marketplace instead of a healthcare system.

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