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Cancer agency a sign of greater tests to come

The Government’s long-awaited cancer plan has finally been released, and will go some way toward easing pressure for action - but its biggest test on healthcare is yet to come, Sam Sachdeva writes.

As a former Labour minister, Pharmac chairman Steve Maharey knows all too well the pressure politicians face from their constituents.

Perhaps that was why when speaking at the Government’s unveiling of its cancer action plan, Maharey paid special tribute to Blair and Melissa Vining, whose struggles with the health system over Blair’s stage-four bowel cancer led to a petition signed by 140,000 Kiwis calling for a national cancer agency.

“This is the problem with politicians: there are so many things that people want them to do instantly, and so one of the things that has to happen is people have to stand up and make it happen, and you have,” he told the couple.

They got to see their wish, at least in part, with Prime Minister Jacinda Ardern and Health Minister David Clark announcing the creation of the Cancer Control Agency - sitting within the Ministry of Health, but with the agency’s chief executive reporting directly to Clark.

The agency’s goal is to establish new standards or quality performance indicators to ensure a consistency of cancer screening and treatment across New Zealand, ending what many refer to as the “postcode lottery” that prevails at present.

Professor Diana Sarfati, head of the University of Otago’s department of public health and a cancer epidemiologist, has also been appointed as the interim national director of cancer control.

Sarfati appears a popular pick if her reception at the announcement was any guide, while her work on ethnic disparities in cancer outcomes will be crucial if the Government is to meet the action plan’s goal of achieving cancer survival equity between Māori and non-Māori by 2030. 

The document includes an emphasis on prevention, with the promotion of vaping to reduce levels of lung cancer and greater promotion of sun safety to tackle New Zealand’s high rates of skin cancer.

There is also $60 million of extra funding for the national drug purchasing agency Pharmac to help it buy new cancer medicines.

National stole a march on the Government in July, when leader Simon Bridges unveiled his own plans for a national cancer agency and a boost to Pharmac’s budget at the party’s annual conference.

Responding to the action plan’s release, National’s health spokesman Michael Woodhouse claimed the Government had been “embarrassed into action” - an allegation undercut somewhat by the fact that establishing a cancer agency was among Labour’s election policies, although it is true it has taken the party longer than many expected to make that a reality.

There are no guarantees that cancer patients will benefit from the funding, while Pharmac’s plans to assess funding applications for new cancer medicines in parallel with, rather than following, Medsafe’s safety assessment process “will not necessarily result in more cancer medicines being funded” as the action plan notes.

There is one important difference between the rival plans, however: while National proposed a $200 million fund dedicated to cancer drugs, the Government’s $60m budget increase for Pharmac comes without any preconditions on how it is spent.

The hope is that a rising tide lifts all boats, with cancer drugs among the new treatments on offer thanks to the extra cash - and the agency came to the party on Sunday, with Maharey announcing a deal to fund new medicines for ovarian cancer, breast cancer and leukemia.

But there are no guarantees that cancer patients will benefit from the funding, while Pharmac’s plans to assess funding applications for new cancer medicines in parallel with, rather than following, Medsafe’s safety assessment process “will not necessarily result in more cancer medicines being funded” as the action plan notes.

That operational independence is seen by many as a crucial part of New Zealand’s success in securing the best deals possible from “Big Pharma”. Ardern certainly seems to hold that view, but the impassioned campaigning from those who believe Kiwis are being short-changed as a result is unlikely to cease.

A DHB shake-up?

The cancer announcement has also highlighted a broader structural issue with the country’s health system - the inconsistency of performance and outcomes among the 20 district health boards (DHBs) who provide care to different parts of New Zealand.

In a question at the announcement, Melissa Vining singled out problems with her husband’s local DHB as a factor in his poor care, with no consequences for poor performance.

That has no easy answer, as Ardern acknowledged: “We rely locally on making sure that our DHBs are offering and meeting the needs of their local community in healthcare provision, but if things go wrong there aren’t a lot of things that can be done at the centre to lift that performance.”

That could be about to change: Clark suggested one “big solution” could come through the health and disability system review being carried out by Heather Simpson, Helen Clark’s former chief of staff.

Simpson is due to deliver her final report next March, but the Health Minister said an interim version would be released “very soon”.

If the push for greater centralisation is extended beyond cancer services to the health system as a whole, through drastically reforming or even scrapping the DHB model, making that a reality carries both a high risk and potentially a high reward.

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