More than a pinky promise: What were they thinking?

Since the Government failed to deliver cancer drug funding in this year’s Budget, the brutality of that broken promise has emerged

I made a mistake by not taking the National Party’s election pledge to fund 13 cancer drugs seriously.

I knew enough about our health system to know election promises are not included in the flowchart that makes up the Pharmac funding and purchasing model. As a result, I didn’t think hard enough about the consequences of that promise and its inevitable breaking, that people with cancer and their whānau would take the politicians at their word.

Since the Government failed to deliver cancer drug funding in this year’s Budget, the brutality of that broken promise has emerged. Patients who have believed in, and staked their lives on, it have been devastated.

And they will not let the Government move on to the next news cycle, or be assuaged by claims of procurement complexities, which might as well be code for “what the hell are we doing here?”

Because that is what is most puzzling about this sad state of affairs. How is it that the National Party and its advisers ever thought it was a good idea to go to the polls promising specific cancer drugs? Make promises for more funding for Pharmac, for cancer support agencies, for drug development, for training oncologists. Don’t promise something you can’t control.

The clue can be found right at the end of the National Party’s election policy document, “Helping more Kiwis fight cancer”, still on its website. It reads: “Prioritising funding for cancer treatments over additional untargeted prescription subsidises for those who can afford them shows what New Zealand can achieve when health funding is guided by health needs and common sense, not politics.”

Yes, you read it there: “Common sense, not politics."

When National released its pre-election health policy document last October, professor of health policy at the University of Auckland Tim Tenbensel noted that parties promising to fund new medicines on the campaign trail chip away at Pharmac’s credibility. “It could come back to bite them further down the track.”

In March, reporter Stephen Forbes took a closer look at the promise. He found that of the 13 drugs; three had already been, or recommended to be, declined for failing to meet Pharmac’s funding criteria; Pharmac hadn’t received applications for another three; and six of the remaining drugs were on Pharmac’s options for investment list, that is, therapeutics it has recommended and could fund if and when its budget allows. Did anyone check this before the promise was made?

More recently, we followed up with Cancer Control Agency Te Aho o Te Kahu chief executive Rami Rahul who was adamant the report from which the 13 drugs were extracted – an analysis of cancer drugs funded in Australia and not New Zealand – was never meant as a shopping list.

Indeed, the report, published in April 2022, contains qualifiers warning that the fact drugs are funded in Australia does not necessarily equate to gold-standard treatment.

It also states very clearly that ensuring the availability of drugs alone are not enough.

“Even within this analysis, it is clear that the full benefits of cancer medicines can only be realised if the ‘pipeline’ of cancer care [from screening and early detection through to diagnosis, staging, treatment, follow-up and supportive care] is working well and equitably.”

No one, I suspect, has done any analysis of those additional costs. The prime minister, finance and health ministers have all defended the policy and say the funding for the drugs will be forthcoming. They blame delays on procurement complexities.

That’s health, it’s complicated. Just because you want something doesn’t mean you get it – no matter the number of votes. This promise is going to be extremely costly for National. Mind you, ACT Party leader David Seymour is sitting on the sidelines as associate health minister (Pharmac). Who knows how that will feed into the outcome?