Pharmaceutical industry payments to NHS trusts in England: A four-year analysis of the Disclosure UK database

<strong>Introduction</strong>: Although hospitals are key health service providers, their financial ties to drug companies have been rarely scrutinised. In developing this body of work, we examine industry payments for non-research activities to National Health Service (NHS) trusts – hospital groupings providing publicly funded secondary and tertiary care in England. <strong>Methods</strong>: We extracted data from the industry-run Disclosure UK database, analysing payment distribution descriptively and identifying trends in medians with the Jonckheere-Terpstra test. The payment value and number per NHS trust were explained using random effects models. <strong>Results</strong>: Between 2015 and 2018, 116 companies reported paying £60,253,421.86 to 235 trusts. As a share of payments to all healthcare organisations the number of payments to trusts rose from 38.64% to 39.48%, but their value dropped from 33.01% to 23.61%. While the number of all payment types rose, fees for service and consultancy and contributions to costs of events increased by 61.55% and 29.43%, respectively. The median payment values decreased significantly for trusts overall, including those with lower autonomy from central government; providing acute services; and from four of the eight regions of England. The random effects model showed that trusts with all other service profiles received a significantly lower value of payments on average than acute trusts; and trusts from East England received significantly less than those from London. However, trusts enjoying greater autonomy from government did not receive significantly more payments than others. Trusts also received significantly lower (but not fewer) payments in 2018 than in 2015. <strong>Conclusion</strong>: NHS trusts were losing importance as funding targets relative to other healthcare organisations. Industry payment strategies shifted towards engaging with NHS trusts using events sponsorship, consultancies, and smaller payments. Industry prioritised payments to trusts with specific service and geographical profiles. More granular disclosure is necessary to understand the role of corporate funding across the health system.