Blue Jackie: Debate on Crown Entities Public Organisations  and State Enterprises — In Committee 
Blue Jackie: Debate on Crown Entities Public Organisations  and State Enterprises — In Committee 
[Volume:631;Page:3076] 
Dr JACKIE BLUE (National) 
: 
 I want to talk about Pharmac and the national medicines strategy. The question I want to ask is why New Zealanders have to wait so long. Over 8 months ago during the election campaign Peter Dunne said he would review the role of Pharmac to ensure not only that pharmaceuticals would be made available at the most competitive price but also that the interests of individual patients would be taken into account when funding decisions were made. Last month it was announced that the long-awaited medicines review was finally under way but that a consultation document would not be available until the end of the year—over a year after Peter Dunne promised it. There is more. It was also announced it would be another year before a final document would be ready. I say to colleagues that it looks as though it will be election year before a final report will be ready. How convenient that is! 
No mention has been made in the national medicines strategy review of a forum where members of the public—ordinary New Zealanders—can express their views face to face. That is an appalling indictment. The main focus of the strategy will be on quality access and the rational use of medicines. I point out that there is an urgent need for an operational review of Pharmac. Applications for funding take far too long to be decided on. The average application in New Zealand takes about 3½ years which compares with 9 to 10 months in Australia. There seems to be no rhyme nor reason as to how drugs are referred from Pharmac’s advisory committee—the Pharmacology and Therapeutics Advisory Committee—to one expert subcommittee or another. Sometimes that advisory committee thinks it has the expertise to make important decisions about complex drugs and complex situations and bypasses the expert committees completely. 
I will take as an example the saga of the diabetic insulin drug Lantus—a very valuable drug according to the medical community. Following an application for funding in July 2004 the drug was assessed as being of only low priority by the advisory committee. Lantus was then referred to the diabetic subcommittee which was fortunate but it took a staggering 10 months to meet. When the subcommittee finally met the expert subcommittee gave the drug a high priority for funding a decision that was completely at odds with the advisory committee’s position. Now 2 years later it is hoped that a decision about Lantus is not far away. Incredibly that rate of progress is considered to be quick by Pharmac’s standards. 
I think Pharmac sometimes thinks it is doing a fabulous job. It is proud of the fact that pharmaceutical spending has flatlined over the last few years. It is proud of the fact that it takes over 3 years to fund drugs. When Pharmac told the Minister of Health that New Zealanders have access to more medicines than Australians do it was very proud of that fact until it was pointed out that that included things like condoms bandages and peak flow meters. What an embarrassing oops! The reality is that New Zealanders are being short-changed on the total number of medicines and also short-changed by the use of special authorities and other rationing mechanisms that mean the number of people who are eligible for drugs is severely restricted. 
I have been led to understand that the Pharmac model has been praised internationally and that countries like Canada are looking at adopting the model at this very moment. I doubt whether they will do so when it is pointed out to them that severely restricting the access to innovative drugs will have a negative impact on health outcomes and also that Pharmac’s preference for being the sole supplier as a means of getting the price lower is risky and eliminates consumer choice. Although that approach has saved money it has prevented patients—consumers—from receiving the treatment they need. 
Pharmac’s approach has produced a rigid divisive silo mentality. Its antagonistic and hostile attitude has meant that a number of pharmaceutical companies have downsized or left the country completely. 
Dr Jonathan Coleman 
: Yes. 
Dr JACKIE BLUE 
: That is right. I say to colleagues that unfortunately tens of millions of research and development dollars are leaving with those companies. 
Dr Jonathan Coleman 
: Out of our economy. 
Dr JACKIE BLUE 
: Yes—overseas. I say to members that research and development money would not only help to fund new drugs and improve people’s access to drugs but would help to retain our doctors and attract them back from overseas. 
Pharmac’s attitude has dumbed down the whole sector. In 2004 only 600 people were working in the pharmaceutical industry in New Zealand—down from 1000 in 1990. Members can compare those numbers with Ireland’s. Ireland which has a similar population to New Zealand has over 12000 people working in the pharmaceutical industry. I ask colleagues whether it is any wonder that New Zealand is considered to be a backwater. 
New Zealanders deserve better than that; they do not deserve only a limited access to the drugs that Pharmac has denied them. Pharmaceuticals and early intervention with drugs can improve outcomes and save lives. Pharmac has been far too Scrooge-like in its whole operation and it needs a complete and an utter review. The national medicines review does not go far enough and it is not happening soon enough. 
Hon Tony Ryall 
: And it doesn’t involve the public. 
Dr JACKIE BLUE 
: It does not involve ordinary New Zealanders who deserve the right to have a face-to-face meeting with Pharmac officials so those officials can see the human toll that denying patients access to drugs has and what that really means to ordinary New Zealanders and their families. 
I will now talk about the district health boards and the waiting lists. I was told of a horrifying story last week. A woman in Waikato who was aged 39 found a breast lump. That is a pretty scary situation for any woman no matter what her age is. She found the breast lump and went the next day to her general practitioner who acknowledged there was a breast lump and also found lymph nodes in the armpit. Naturally the general practitioner wrote an urgent referral to the Waikato District Health Board. One would have expected the lady to be seen quickly and without any problem but she was not seen quickly. In fact she received a letter from the district health board stating it was very sorry but it could not see her for 9 months—a 39-year-old woman with a breast lump! 
Jo Goodhew 
: That’s appalling. 
Dr JACKIE BLUE 
: It is appalling. 
Although the district health board offered that woman a mammogram without a specialist appointment I point out that that is bad practice. I have taught breast medicine over many years and I say that is bad practice. One should never do just a mammogram in the case of a woman who has a breast symptom; a specialist has to do a breast check an ultrasound and a biopsy. That district health board was forced to take short cuts and that is terrible. It was put in the terrible situation of being under-resourced and all it could do was to send the woman back to her general practitioner with a mammogram but without the gold-standard treatment that the woman needed. I say to colleagues that it concerns me that if the woman had decided to go with the mammogram alone the mammogram might have been negative. A percentage of mammograms do not show up cancer. What could have been worse just before Christmas was that the woman would have had her mammogram and been reassured that all was well so she would have gone off on her Christmas holidays thinking all was well. That would have been a worse situation for her to be in than to have had proper treatment. 
The Waikato District Health Board breast surgeon explained when asked why the woman had to wait 9 months that it was short of a doctor at the breast clinic. I understand the lack of resourcing at the breast clinic was the lack of a breast physician. I say to members that I have been lobbying for breast physicians to be in district health boards for years and years. Breast physicians are an important resource and they are not recognised in BreastScreen Aotearoa which is a tragedy. They are cost-effective they can be used in situations like that and they should be in every district health board’s breast clinic. Breast physicians can see women in an efficient and a cost-effective way so I hope the Minister takes up the challenge and looks at district health boards employing breast physicians. 
Fortunately the woman concerned found the money to be seen privately which was good for her. But what would other women do if they did not have the financial resource or the family support to enable them to be seen privately? So I am very concerned about the waiting lists. That woman is just one example but there are many examples of people being culled off waiting lists and being sent back to their general practitioners when they should be seen by specialists. Those New Zealanders have earned the right to be seen by the public health sector within an appropriate time frame and if there is a problem with regard to the workforce or money then it needs to be sorted out here right now. 
I am greatly concerned about how general practitioners in this country are being told how to set their fees. They are being treated like people who cannot manage their own businesses. The Minister seems to be fighting with them all the time. They deserve better treatment than that. General practitioners do a very good job in this country. They are at the coalface for patients managing them and being there for them on a daily basis. General practitioners deserve the right to be listened to and treated with respect. If they feel that patients should be seen by specialists in hospitals then that should be utterly respected. They should not be treated in the way they are at present. General practitioners are being bossed around bullied and fought with. They deserve much much better treatment than that. 
Part of my interest in the health portfolio relates to the non-governmental organisations. Those organisations are quite diverse. They range from Plunket to the Order of St John to health promoters and so on.