Little AndrewDr ELIZABETH KEREKERE (Green): Kia ora e mihi atu ki te ki a koe e te Māngai me te rangatira e te Minita. [Hello and greetings to you Madam Speaker and to my esteemed colleague to the Minister.]I have two questions or two groups of questions. The first one: as a member of the Health Committee—the very hard-working select committee that it is—we started the term with 53 petitions. We have cleared that backlog pretty much but the bulk of them were about of course Pharmac funding particular types of medicines particularly for people with rare disorders but also for things like cancer; something that has been approved for one use but has the potential to be used for multiple uses. I bear in mind a recent petition one we're dealing with at the moment from Carmen Shanks on cystic fibrosis. I acknowledge her and the work she has done in sharing her stories with us and also Cystic Fibrosis New Zealand and the advocacy they've done in this area for Trikafta.When we're looking at the review that's been done and the Government's response to it I wonder when you're looking at the broader picture of how we do equity is there any proposal that you will look at those things and think Well if somebody with cystic fibrosis"—for example—"has access to this medication which means they're not going to hospital every few months for usually one to two weeks at a time"—which has been estimated through that petition at $40000 a time or $60000 estimated for a lung transplant. It's a massive massive pressure on the health system for that. So I think that in that bigger picture the potential to offset rather than just have the contained amount of "This is Pharmac funding this little box here."—to say "Right we're going to save substantial money over here. How can we do something that just acknowledges the impact it will have in the longer term?" So yeah I'm interested to hear about that.Then the second one is always about the commitment to trans and non-binary healthcare the intersex guidelines. I'm interested to see where the progress is up to with that and just acknowledging also we weren't successful in the advocacy at the time of Pae Ora to get a rare disorders strategy being written but now it looks like that is going ahead. We're still advocating for the medicines. So I acknowledge my colleagues across the House who have been advocating strongly for that. It looks like that will need to go ahead in order for things to work. So I've accepted we're not having a rainbow strategy just yet. But again where are things up to especially given the recent commitment to intersex healthcare and providing guidelines inside the health service? Kia ora.Hon ANDREW LITTLE (Minister of Health): Thank you Madam Chair. I thank the member Elizabeth Kerekere too for those questions and I'll do my best to assist. I'm just conscious on the second question the member has asked my colleague the Hon Dr Ayesha Verrall has portfolio responsibility and she is unfortunately unwell at the moment.Hon Members: She's here.Hon ANDREW LITTLE: Oh she's here? She's handed in her sick note! She will very quickly hand me a couple of little points on that—except to say I can say in two respects Dr Verrall has been at the forefront of ensuring that some of the intersex medical care that I think our system had not been providing particularly well previously has now stepped up and there is now I think a more solid commitment within the system as a consequence of Dr Verrall's leadership in that respect.In terms of a rainbow strategy I acknowledge the points that the member made through the debating of the bill and it's timely in a way that the member should raise that when we've just seen that the RainbowYOUTH organisation has had to sort of pause themselves for a few weeks while they come to terms with some tragedies that they are dealing with. They are an organisation that we do want to support and continue to support because they do very important work for young people and it confirms I think that it's an area that we do need to be across just as much as we can.On the point about Pharmac and the way it makes its decisions about medicines particularly new medicines I can confirm for the member that in terms of the range of factors when the Pharmacology and Therapeutics Advisory Committee I think they're called make their decision about whether it's appropriate to have a drug—it's a different committee that decides whether or not to fund it—they do take into account those factors: the social factors if you like too; what it will do for sufferers of particular conditions as well. But the committee that then decides on the funding has to sort of look at that with what they've got available.In terms of the comments the member makes about funding some drugs for some indications and not others that is one of the challenges that we've got and that's one of the issues that Pharmac is going through right now with the additional funding that they've got particularly in the cancer space. We know that Keytruda is a classic example. It's funded for some indications but not for others but we know that it's efficacious for other indications. So that's one of the assessments they've been going through right now to make sure that we are up to speed. If I go back to the work that the Cancer Control Agency did under the leadership of Professor Di Sarfati who now turns out to be the Acting Director-General of Health the work that was done on the gap between cancer treatments here and like-minded countries particularly Australia Canada and the UK showed that we've got a gap that we need to fill and I'm confident that Pharmac is focused on that.In terms of cystic fibrosis and the funding of Trikafta I know that Pharmac has been devoting some attention to that. It is on their options for funding list and in fact they've expanded the coverage. A few months ago they indicated that they would fund it where they were able to for those 12 years and over; they've now extended that to six years and over. I do note that they are actively considering proposals from Vertex the pharmaceutical company that supplies Trikafta. So that is all well under way.Just going back to the rainbow health issue too just to acknowledge that there is work going on delivering models of care for transgender patients and making sure that those patient needs are properly taken care of. There are eight primary care centres funded to do that. Just to know that there is some attention being paid to that but I know the member is very keen to see a specific strategy and I'm confident that one day we will have something discreet to point members of that community to to say "This is what you should expect."CHAIRPERSON (Hon Jacqui Dean): Members before I take the next call we have three minutes left and then I will call time on this part of the debate."