Financial Review Debate — Ministry of Health

I am disappointed that the Minister of Health is not in the Chamber this evening.

The CHAIRPERSON (H V Ross Robertson): The member cannot refer to the absence of another member. Each and every one of us at different times has other matters to attend to.

I apologise. The Minister has been strangely silent on the issue of Herceptin funding. The women of New Zealand want to hear from him. They want to know what he is thinking. The only voice we have heard to date is that of Pharmac, and I wonder whether Pharmac speaks for the Minister of Health. I know that women with breast cancer want to know the answer to that question.

To date, Pharmac’s actions on whether it will fund Herceptin have been totally hypocritical. Midway through last year it stated that it wanted to consider only data that was peer reviewed and published in an international journal. That is fair enough, we might say, even though many countries did not feel the need to wait for published material. Indeed, many countries started funding Herceptin from as early as a year ago, on the back of earlier trials and of data that had been presented mid-year at a conference. Pharmac wanted to see that data published in peer-reviewed material, and it got its wish—very recent data did appear in an internationally acclaimed journal.

But what has happened? Pharmac has absolutely ignored the published data, stating—unbelievably—that there is still insufficient evidence as to the frequency and timing of how Herceptin should be used. Rather, Pharmac has done an about-face and has conveniently cherry-picked unpublished data to make the case for a short 9-week course of Herceptin rather than a proven 12-month course. I understand that Pharmac is going around doing a roadshow and showing a PowerPoint demonstration that presents its own in-house analysis of non-published, short-course data in order to make its case. I have a bit of advice for the Minister of Health, and that is to get independent expert advice on Pharmac’s in-house analysis. The Minister could be very surprised.

My colleagues will be very interested to know that Pharmac’s recommendation for a short 9-week treatment is based on the FinHer trial, which involved only 232 women. Half of those women received Herceptin, and only 54 of those actually received the combination Herceptin regime that Pharmac is proposing in this clinical trial. On the back of a 12-month Herceptin trial, in which over 12,000 women participated, with proven results to back it, Pharmac has thrown science to the wind and now wants to back a regime that was used in only one trial that involved only 54 women—the results of which, I might add, were not statistically significant. I will say that again—it is an important point—Pharmac proposes to use the results of an unproven trial that involved only 54 women, as opposed to the proven results from trials that involved 12,000 women, to back its case. It is a case of 12,000 women versus 54. It is astonishing—I am sure members will agree on that. This proposal flies in the face of international opinion and is completely contradictory to Pharmac’s own original requirement that any funding for new medicine would be based on robust clinical evidence before being considered.

Pharmac wants to throw desperate women with aggressive breast cancer a few crumbs in an unproven, cut-price regime, while women in Australia, Finland, the UK, and Canada, along with women in 19 other OECD countries, are already gaining the benefits of a 12-month course. If the trial gets off the ground, New Zealand women will be part of an experiment, the results of which will not be available for at least 5 years. That will mean 5 years of women possibly taking an inferior regime before that was discovered. I wonder whether the Minister of Health has thought about the very serious ramifications of that scenario.

There is a very interesting twist in all of this, in that Pharmac is prepared to invest $3.2 million of what it calls “spare administration money” into this trial. Yes, it has found some loose change to throw at Kiwi women. We should remember that this is an organisation that comes under budget regularly, and last year it came under budget by over a staggering $19 million. Pharmac is an organisation that is more interested in not spending its budget, and it is not at all interested in increasing New Zealanders’ access to medicines. Time and time again we have seen Kiwis’ lack of access to medicines, and access to Herceptin is just another example.

There is a question that troubles me, and I hoped the Minister could take a call and answer it. The question is whether the $3.2 million of taxpayers’ money that Pharmac has found rattling around in its administration budget will be going to fund a clinical trial in New Zealand for New Zealand women, or whether it will end up overseas and not be used for Kiwi women, at all. I hope that question can be answered; it is one that has been bothering me. I do not think Kiwi taxpayers would be pleased to find out that their money was going to fund an international trial that did not involve Kiwi women.

A clinical trial is designed to answer specific scientific questions, and I do not have a problem with that if women are recruited freely and informed, and if they give consent. But what is very unclear in all of this is what women who do not want to take part in the trial will be offered—that is, what women who are off-trial will be offered. It seems to me, from the noises that Pharmac is making, that it is highly probable that women who are off-trial will be offered not the international best practice 12-month course but, rather, the short course. If that is the case, we are in a very murky situation, indeed. Women will not be entering the trial of their own free will. These women, who are desperate to have Herceptin, will be coerced in the hope that with the toss of a coin they will be lucky enough to get the long-arm 12-month treatment. Each and every woman will be hoping that Lady Luck is on her side.

I have one word for a trial in the form I have just described—where women who are off trial receive the unproven short course—and that word is “unethical”. I would be very surprised if an ethics committee would approve a trial in that particular format. But who knows? Pharmac’s tactic so far seems to be one of bullying. It might yet get its own way.

Members might ask what our own experts say about this situation and what our own oncologists advise. CaTSoP, which is Pharmac’s cancer subcommittee, reported in its November 2006 minutes that as a committee it had more confidence in the validity of the 12-month treatment. Its recommendation was for the 12-month regime. To read the CaTSoP minutes makes it clear that the experts were more comfortable with and preferred the 12-month Herceptin regime.

Let us look at a scenario whereby this clinical trial gets ethics approval and begins in New Zealand, and the off-trial option is the unproven short course. I know what I would do if I were one of those women. Yes, I would feel absolutely railroaded. Yes, I would feel very angry. But I would be desperate enough to go into the trial. I would, of course, be hoping that Lady Luck was on my side, that the roll of the dice would be on my side, and that I would get the proven long-arm 12-month treatment. If I were unlucky and did not get the 12-month course but drew the short straw by getting the short course, I would do everything in my power, after the course was completed, to self-fund the remaining 9 months of Herceptin. And many other women would do the same thing. If in time there were a cheaper generic version of Herceptin available for women in this country to bring in themselves, they would do it in droves. The results of any trial would make a farce of it. It would become a complete joke. The results of the trial would be contaminated by women who left the trial at its completion to self-fund and have the remaining 9-month course, and any results would be laughed at by the scientific community. The trial would have no credibility.

The Minister of Health, Pete Hodgson, in response to a question I posed to him in the House, said he would take the views of our experts, who are our oncology community. I seriously urge him to do that now. He needs to do it for women. He needs to start advocating for women in New Zealand with breast cancer.

I wish to spend time speaking on something that is very close to my heart, and that is that subject of aged care. As National’s spokeswoman on aged care, I have been going around the country conducting fora. I am finding a sector that is in disarray. We have growing numbers of elderly folk who are vulnerable and very concerned about their future. I am talking about the older folk who want to stay in their own home and seek access to home-based support services. I am talking about the older folk who, for whatever reason, find themselves in aged residential care—be that a rest home, hospital care, or dementia care.

How do I know about how those people are feeling? It is because I have been out there consulting with the sector—consulting in a listening way—and asking the people to tell me what the problems are for them. I have consulted at fora in my home electorate of Aoraki, and in Auckland, Wellington, Christchurch, Palmerston North, and Hamilton—and other fora have been lined up. Other dedicated National MPs in other parts of New Zealand have asked me to hold fora in their areas, as well. I have visited rest homes in Ōtaki, Hamilton, and many parts of New Zealand, and I have plans to see more. What did I find? I found a workforce in crisis—not just an aged residential care crisis but a home-based support service crisis.

Like many other National Party MPs, I have workers coming through the door of my electorate office and asking me to do something about the way the sector is at the moment. There is not only a crisis of numbers but a crisis of confidence. Most recently in Hamilton I was given to understand that there is frustration on the part of those in aged residential care, because the Minister Pete Hodgson and the Prime Minister repeatedly muddle the fact that aged residential care and retirement villages are not part of one and the same budget sheet. In fact, although some money may be made out of property investments on the part of retirement villages, there is a strong belief that there is no fat in the aged residential care sector—none whatsoever.

Maybe it is a philosophical bent on the part of the Minister and Prime Minister that leads them to say that these particular businesses and providers are ripping off the workers. That might explain why, in answer to a written question, the Minister told me today that he thinks the aged residential care sector is underfunded, and that he has instructed the unions—wait for it—to work with the district health boards to improve the wages. Hang on a minute! What are unions going to do in working with the district health boards to raise the wages? Maybe we will see strikes coming in the aged care sector. I sincerely hope not.

I say to the Minister that it is time to look at the whole sector and at exactly where it is going wrong. It is time to look at the fact that the aged residential care sector cannot afford to dedicate respite beds, so we have carers of the elderly at home getting sick as well as the elderly. It is time to look at the over-auditing—not to survey about over-auditing but to actually do some work to make sure there is some consistency in auditing so that the high compliance costs currently facing the sector are reduced.

It is anti-business rhetoric that makes this particular Government think that the providers are holding out on the workers. We see a Government that is unwilling to recognise through its district health boards that there have been cost implications from the legislation it brought down. I am talking about the Holidays Act and the raising of the minimum wage level. I too believe that workers in residential care and home-based support services need to be paid more, but it is not enough simply to say that more has to be found from the managers. That is not the way in which the Government should be looking at this situation.

I can tell members that this sector is in disarray and will need some serious work. That work cannot be done from Budget to Budget, which is all we are seeing at the moment. In one speech a year the Minister will announce: “Well, I’ll look at it in the Budget. I’ll throw some more money at it in the next Budget, and hope that solves the problem.” I say to the Minister that it is not good enough.

I stand to take a call in this discussion on the financial review of the 2005-06 year in the health portfolio. I want to draw attention to a number of things, and rather than focusing on single issues as the previous two speakers have done, I would like to try to traverse some of the gamut of the health portfolio and to demonstrate not only the complexity of the portfolio—which seems to escape members opposite, who enjoy the luxury of focusing on single issues—but also the successes in the performance of our health sector in the 2005-06 year.

We are frequently asked, when we say we have put an extra $2.2 billion into the health sector over the last 7 years, what we have to show for that investment. In fact the 2005-06 year is a very good year to look at for a return on investment in the health budget. What we can see in the roll-out of primary health care in particular, and the primary health care strategy of this Labour-led Government, is, first and foremost, a cut of about 50 percent in the cost of going to most doctors. That really reverberates for families right around the country. When they know that it now costs them about half of what it used to cost them to go to the doctor, it makes a difference. When we couple that with the lowered cost of prescription drugs, we know we are on to something that really makes a difference to New Zealand families. That is a success story.

Another thing I draw to the attention of members is that last year—the year under review—the Commonwealth Fund did some research on the health systems of seven OECD nations, with most of the 2006 information focusing on primary care. New Zealand came out first or second in roughly 60 percent of the indicators. Let me give some examples. Amongst the countries surveyed were the Netherlands, New Zealand, the United Kingdom, the United States, Australia, Germany, and Canada—countries that we like to compare ourselves with. Some of the highlights of that research showed that 90 percent of general practices in New Zealand have after-hours care arrangements, second only to the Netherlands and twice the rate of the United States. New Zealand general practitioners had the second-highest rate of utilising electronic patient records. New Zealand practices reported the highest usage of electronic laboratory results and hospital records, and New Zealand’s 5-year breast cancer survival rate was higher than the average of the seven countries, and better than that of Australia and Japan. On top of that, we have had an increase in the number of hip and knee replacement operations, and in the number of cataract operations. That was a significant election commitment by the Labour Party in the 2005 election.

I want to talk about the secondary health sector for a moment, although clearly the primary health sector is at the forefront of our movement in the health portfolio. In the secondary health sector we are funding, in addition to the extra hip and knee replacements and cataract operations, 10,000 extra elective surgery procedures over the next 4 years. Let me tell members some other success stories. If we were to listen only to a diet of Opposition speeches we would think that nothing good ever happened. Well, it is about time there was some balance in some of that information. I met with all three district health boards in Auckland last Friday afternoon. All three of those boards are now predicting that in 2007-08 they will break even.

Opposition members ask where we are seeing productivity. I can tell them that the Counties Manukau District Health Board is reporting a 4 percent productivity rate in the last year, and it will break even in the next year. There have also been huge successes and advances in the level of service that the Counties Manukau District Health Board—if I can use it as an example for a moment—has been delivering. It has been seeing something in the order of 750 people daily in schools. [Interruption] If members opposite listen to this they may learn something. Something really important that has been vexing us is obesity and diabetes; hence the inquiry that the Health Committee is engaged in at the moment. Because of some of the interventions of the Counties Manukau District Health Board, it can report that one school in its area has in the last year seen a drop in the body mass index of its year 9 students from, on average, 35 to 17.5—in 1 year. That kind of activity and intervention on the ground by a district health board, financed and supported by the commitment of this Labour Government, cannot be ignored.

The end of the 2005-06 financial year under review was when the first of the big multi-employer collective agreements came into effect in the health sector, which was the agreement affecting nurses. As at 1 July last year nurses got to $54,000 at the beginning of their fifth year of employment. That was because of a huge commitment to pay equity and equal pay for work of equal value. We applied that in the health sector because it was an area where it was needed. Last week the Capital and Coast District Health Board came to the Health Committee and reported that since those pay rates have been in place, the nursing retention rate at the Capital and Coast District Health Board has improved dramatically. It had a turnover rate in the order of 37 percent annually. It has now dropped to something in the order of 13 percent. So the money put into the wages and salaries of the people who work in our hospitals is paying off. That money has flowed across the health sector and across the various health professional occupations. What we are seeing for all those health professionals is improved retention and recruitment rates. Those things are testament to the success of the efforts of this Government in the 2005-06 year, in particular, and in earlier years.

I could talk about the fact that the mental health workforce has grown by 26 percent since we came into Government. I could talk about more training places for general practitioners and an extra $2 million to increase the number of general practitioner training places by over 25 percent for each of the next two training years. Enormously good things are going on.

There is an increase in productivity. In fact, our hospitals are busier than they have ever been, so there is an increase in activity. Hospitals report to us that in the 2005-06 year total in-patient surgical activity has increased by 5.7 percent. The number of New Zealanders receiving elective surgery has increased by 6.2 percent—on a case-weighted basis, that is 21.3 percent. Medical discharges reached 317,000 in 2005-06. That was a 29.5 percent increase on the figures of 1999-2000.

The figures go on and on. Money is being poured into the health system at the primary end and at the secondary end, and the productivity that is coming out of that is absolutely palpable. One other report from the Auckland District Health Board last week stated that that district health board was looking for hips. If members know of people who need hip replacements, then they should point those people in the direction of the Auckland District Health Board if their local one does not have the capacity. That is how the system works; people can be transferred.

The CHAIRPERSON (H V Ross Robertson): Before I call the vote, I just say to members that interjections are not permitted at all when they are directed at a member who does not have the call. I am looking to my left and my right.

Report noted.

Ministry of Justice