8. Hon TONY RYALL (National—Bay of Plenty) Link to this
to the Minister of Health
What are the goals of the Government’s Primary Health Care Strategy, and what mark out of 10 would he give for progress on meeting those goals to date?
Hon PETE HODGSON (Minister of Health) Link to this
There are many goals. One of them is to make primary health care more affordable for all New Zealanders, and towards that goal progress is faster than was originally planned.
Does he accept the analysis of the New Zealand Primary Health Care Strategy in the latest edition of the British Medical Journal, which says that the Government does not have a clear vision of what it wants for primary care, and that questions abound over whether the reforms have been worthwhile; and how can it be that progress in improving quality is still so hopeless after spending $1.2 billion of taxpayers’ money?
The recent British Medical Journal article to which the member refers, though published only recently, draws substantially on material that is several years old. For example, just over half of the bibliography material was published in 2001 or earlier. Things have moved since then, and they continue to move.
Barbara StewartDoes the Minister share the concern of Auditor-General Kevin Brady and health economist Bronwyn Howell that the limited accountability of public health organisations makes it difficult to assess whether patients are receiving the benefits intended in the Primary Health Care Strategy; if not, why not?
The member may be unaware that pursuant to the roll-out of the second to last phase of the Primary Health Care Strategy on 1 July this year, a number of steps were taken by the Government and agreed contractually to address those concerns.
Maryan StreetI have received a number of reports that primary health organisations are now moving on from the implementation phase and that real gains are being made. Thanks to the reduction in fees alone, we are now getting reports that those with the highest need for services are going to their doctor, getting treatment, and picking up their prescriptions more reliably. I note again that work to lower the cost of seeing the family doctor is opposed by the National Party.
Judy TurnerCan the Minister outline the impact he anticipates of having a robust national medicines strategy on his ministry’s ability to better deliver on the Primary Health Care Strategy?
It seems to me that about a third of that strategy, released earlier today for discussion, particularly addresses the primary health care aspect of our New Zealand health system. I can see significant changes in the way that we deal with community pharmaceuticals and community pharmacies, and I think that the response from the public over the next few weeks, until 30 March, will be instructive in helping the Government to work out how to better improve medicine management.
Is the Minister telling the House that a report written in the British Medical Journal published on 9 December, co-written by an adviser to the Government and Treasury, is seriously out of date; and what did he mean when he told Cabinet that progress towards the strategy’s aim of improving coordination between primary care and hospitals is “still weak”, despite spending $1.2 billion?
Rt Hon Winston Peters Link to this
Can I ask the Minister—seeing that this is the last question time for 2006—whether, because primary health care quickly shades sometimes into secondary health care problems, Pharmac received advice from its cancer treatments subcommittee that Herceptin should have a low priority for funding; and is there not a conflict of interests here, where the advisers—or adviser—who recommended against the public funding of Herceptin stand to make profits out of making it available privately as private practitioners, and then on top of that the Government charges GST in such circumstances? Is he aware of that; if he is, does he propose to do something about it?
I need to answer that question from memory, so there is that caveat. From memory, the recommendation of the cancer treatments subcommittee, the original group of people who looked at it, was that it was not a low but a low-medium priority. Secondly, the cancer treatments subcommittee is obliged to look not at cost-effectiveness but at effectiveness only, and the Pharmacology and Therapeutics Advisory Committee, which then looked at cost-effectiveness, made a similar recommendation.
Can the Minister confirm that in his $1.2 billion funding for the Primary Health Care Strategy he has funded the Care Plus programme, which has an objective of providing care in the community for people with chronic illnesses, like diabetes and heart disease, to keep them out of hospital; and can he explain why an evaluation of this programme shows that being enrolled as Care Plus patients actually increases hospital admissions by 40 percent?
The member continues to confuse and/or delude himself. The Care Plus programme was originally devised by the sector itself. [ Interruption] The member may wish to listen. [] The member does not wish to listen, so should I give an answer if he does not wish to listen?
Madam SPEAKERPlease, members. Sandra Goudie has a loud voice. It is creating disorder. The member is on her last warning. Other members in the Chamber wish to hear the Minister’s answer.
I would say to the member that Care Plus was originally devised by the industry—in other words, by folk from the Independent Practitioners Association Council. It was then instituted, as amended by the Ministry of Health. The uptake amongst primary health organisations exceeds 80 percent. There are, however, problems with it, so the Care Plus programme has been under review. The review is coming forth to the Government presently. Changes will be made.
If the programme is a success, can the Minister explain why a programme that is designed to keep people out of hospital actually increases the likelihood of those people being admitted to hospital, and is that not exactly what the British Medical Journal was reflecting: that this Government has no idea of what it wants to achieve?
The member makes it up as he goes along. If I may be blunt, the member needs to decide whether he intends to be command and control and prescriptive, which is what his question implies, or whether he wishes to get rid of the Primary Health Care Strategy in its entirety and double doctors’ fees for New Zealanders, which is what National’s policy currently states.
Jo GoodhewHow does the Minister explain the disconnection between New Zealand’s apparently improved access to general practitioners and our record of access to elective surgery and hospital care, as reported in the Health Affairs policy journal, where long waiting times are reported—a frightening 85 percent of the time worse than those in Australia, Canada, the US, the Netherlands, Germany, and the UK?
That refers to research that was carried out earlier this year. In September of this year, 8 years after the policy was originally announced by National, most district health boards finally became compliant with the policy of successive Governments, which is to provide service within 26 weeks to folk who are entered into the elective surgical system.
Does the Minister believe that the next extra dollar of health spending should be spent under the Primary Health Care Strategy, where the Government has no idea of what it wants to achieve, or would he prefer to put the money towards reducing cancer waiting times, now that a report out in the last few hours shows that waiting times for radiation therapy at Palmerston North Hospital have now stretched to 18 weeks—18 weeks, Minister—four times the recommended safe period for treatment?
It is very hard to hear, with constant interjections. The member has asked his question. Please let us hear the answer.
Because the Labour Party went to the election last year without having reckless tax cuts on its mind, we do not need to concern ourselves with how we spend an extra dollar. We can concern ourselves with how we spend—
Rt Hon Winston Peters Link to this
Down at this end of the House we can barely hear any of the answers, because members of one particular party in the back bench are shouting at the top of their voices. I suggest you give them an early Christmas present or an early holiday, and ask them to remove themselves from the House, because, frankly, they have had every possible warning. We are coming now to the last of our questions; they have taken no warnings at all and are carrying on in the same way as before. They have been in Parliament only 5 minutes, so what is special about them?
I have sympathy with the member’s point. I hate to say this, but it is the back row. Would you please keep your interventions minimal for the rest of this session. I ask the Minister to repeat his answer.
In brief, this Government does not have reckless tax cuts on its mind, and as a result does not have to worry about how to spend one extra dollar. We have lots of money to put into health, and we are spending it well and wisely.
I seek leave to table a number of documents. The first is the analysis from the latest edition of the British Medical Journal.
Secondly, I seek leave to table the report, which the Minister said was soon to be released, into the review of the implementation of Care Plus that shows that it increases one’s chance of going to hospital.
Thirdly, I seek leave to table a report out this afternoon that shows that waiting times for cancer radiation therapy in Palmerston North are now at 18 weeks.