Little AndrewHon ANDREW LITTLE (Minister of Health): Thank you Madam Chair and I thank Dr Shane Reti and the Hon Michael Woodhouse for their contributions. There's a lot of what Dr Reti said I actually agree with in relation to Pharmac and I think the concerns about Pharmac's sort of isolation have been around for a while let's be brutally honest. I'm not going to blame politics here. It was because of the crescendo of concerns around it. That's what prompted us to think seriously about a review. Promises were made on the campaign trail in the last election from both sides of the House and so we committed to the review. What I took from the report was that rather than Pharmac being solely responsible for everything to do with medicines and pharmaceuticals actually you did need a broader framework within which to consider that. It is properly the province of the ministry as the overarching sort of steward of the system and the centre of policy and intellectual capacity for the health system to actually be leading that work and the review report said that specifically in relation to vaccinations but actually it needs to be for medicines as well. So part of what we've agreed to in relation to the independent review is that Pharmac will be required to work closely with others—in particular the ministry—and I'm confident that we will now see that. So the member asks does the bill take account of the concerns in the report and I'm confident that it does. I mean bearing in mind that at the time I had the report the bill was fully in the possession of the select committee so it wasn't a question of fiddling around with the bill before we introduced it to the House. Pharmac very early on—in fairness to them—said they didn't understand why they were excluded in the first draft of the bill from being regarded as a health entity for the purposes of the bill and therefore subject to the health sector principles. They now are. They're defined as a health entity" and they are now subject to those health sector principles. So I think it does—those health sector principles will make a significant difference to the way that board and its management will have to conduct themselves in Pharmac. To Michael Woodhouse: again Woodhouse raises some important questions about that and again he asks whether I had given thought to any further changes in Part 3. I'm confident that no further changes were required. The critical thing is that Pharmac is treated under this bill—the piece of legislation for the health system—as part of the health system and even though they are under the Public Health and Disability Act 2000 at the moment like most things in that Act their isolation is almost confirmed. They cannot possibly be isolated given the way this bill is drafted and the structure that we're setting up and in any event it will be partly this statute but partly also the political process will drive them to have to integrate properly with the rest of the health administration in order for them to do their job properly because I don't think they're going to be able to avoid it. With the Māori Health Authority because it will have some intellectual capacity as well as its developing policy and strategy for greater equity performance and improvement they will have a critical role to play in their engagements with Pharmac to see that Pharmac lifts their equity performance as well. So my point would be that it is covered off in the legislation as it is."