The Future of Health

Introduction

Good afternoon and thank you for having me.

Every person in this room knows New Zealand's health system is under pressure. GPs have waiting lists longer than a hospital corridor and the corridor is where some of the treatment is needing to occur in hospitals.

I want to start by recognising our doctors, nurses, pharmacists, specialists, and everyone else working in healthcare. They do a tremendous job, often in very difficult circumstances. It’s not their fault that they’re treating people in hospital hallways.

The problem is getting the patient in front of that person in time. According to the latest Health Survey, one in four adults and one in five children had a medical problem but did not see a GP because the wait for an appointment was too long. Those figures have roughly doubled since 2021/22. At the same time, health funding has increased by 35.4%. When someone tells you money is the problem, I’m afraid to say, that just doesn’t stack up.

New Zealand is not short of expertise. We have good medical schools, talented professionals, and access to extraordinary advances in medical science. Today, researchers in Wellington are trialling therapies that use a patient's own immune system to fight cancer with CAR T-cell therapy.

New Zealand has the potential to be world-leading in healthcare, but like so many other industries a malaise has settled, and we’ve drifted back in the pecking order. I put it down to a few things:

1. Our economy isn’t productive enough to keep up with other countries, and this is evident in the money we spend on medicines.

2. We’ve grown too accustomed to bureaucracy, and haven’t asked the question ‘will this make the boat go faster’ when adding to it. The bureaucracy and red tape puts limitations on what clever and talented people can achieve.

3. We don’t have the facilities that compel talented people to stay. These professionals want to save lives, if they can save more at facilities in Melbourne or Toronto, then that is where many will go.

The sugarhit policies we’re seeing from other parties won’t arrest the decline. ‘Three free doctor’s visits’ is the type of thing that comes up when you run people’s concerns through ChatGPT and get the simplest policy relayed back to you. It will possibly win votes, it won’t help anyone because it doesn’t answer any of the above questions. It is the type of cynical politics that is quite sad, because it takes a real concern for many people and offers them false hope.

New Zealand is not the wealthy nation it once was and healthcare is one area where the effects are most evident. We need more productivity in this country if we’re going to afford the first world living standards we’re accustomed to. That is central to ACT’s offering this election, but it is not what I’m here to talk about today. I encourage you to read ACT’s Fiscal Plan to see our plan to end wasteful spending and grow the country.

My perspective

Health has played a big part in my life. My mother was one of the last New Zealanders to contract polio, only months before the vaccine arrived. Against all odds she worked her way up to the prestigious role of Chief Pharmacist for Northland. I used to say she was Northland’s biggest drug dealer.

I learnt from her how much knowledge and responsibility sat behind the counter of a pharmacy. And through her own illness I saw the importance of modern healthcare.

As one of the last people in the Western world to contract polio as a baby, she was told she would not walk, work, go to university, drive or have children. She did all of that and more, through her incredible determination and because of the healthcare available in New Zealand.

It's one reason I sought responsibility for Pharmac. At the last election I saw political parties use specific medicines as a vote buyer, completely undermining the independence of Pharmac and jeopardising the funding model. I feared that the model would change from being an evidence-based model targeting need, to a model where politicians chose what was funded based on political benefit. I could not let that happen, and I’m proud that this election I haven’t seen any parties make the same cynical promises, and that there appears to be consensus on increasing medicines access.

We have made progress this term. Since becoming Minister for Pharmac the Government has given Pharmac its largest ever four-year budget, now $7.2 billion. Since we took office, Pharmac has funded 48 new medicines and widened access to another 88. Around 767,000 New Zealanders are expected to benefit from those decisions in their first year of funding.

ACT has made some other important changes in Government. We abolished the Māori Health Authority and removed race-based provisions from health law. We believe treatment should be based on individual need, not ancestry. We brought back measurable targets, because waiting times and treatment outcomes matter more than organisational charts.

We have also opened the door wider to private providers. Under the Government's Elective Boost, more than 16,000 additional procedures were delivered in its first phase, including cataract operations and hip and knee surgeries. If there is capacity in a private operating theatre, and a public patient needs an operation, we should be using it.

But we have only started. I want to focus on two areas where relatively practical changes could make an enormous difference, primary care, and medicines.

Primary care

First, primary care.

Every untreated condition carries the risk of a more serious, expensive problem later. It is the first line of defence in the health system but because of the difficulty getting an appointment, many people end up in ED as their first brush with the health system.

We can greater utilise our existing workforce by shedding some of the restrictions preventing them from unlocking their potential.

There are more than a thousand community pharmacies contracted with Health New Zealand. Pharmacists are highly qualified professionals who understand medicines, side effects, interactions, and when a patient needs to be referred on.

Technology has also changed their work. Robotic dispensing means pharmacists spend less time counting and pouring, and can spend more time using their clinical training.

Meanwhile, community pharmacies are coming under pressure from big box retailers who can charge lower prices.

We have trained professionals, a network of premises, and patients who need care. It would be foolish not to make better use of them.

This year, the Government expanded funded pharmacy services for common conditions, including uncomplicated urinary tract infections, conjunctivitis, head lice, scabies, and oral rehydration for children. That's a useful start.

ACT wants to go further with our Pharmacy First policy. We would allow pharmacists to assess and treat more everyday conditions, such as sore throats, minor skin infections, and gout, within clear clinical protocols. They won’t take the place of a specialist or a GP, but a patient won’t need to wait for a GP when a pharmacist is appropriately qualified to help.

We also want accredited pharmacists to manage routine aspects of stable long-term conditions.

For example, about 1.1 million New Zealand adults take medication for high blood pressure. Not all would be suitable for pharmacy monitoring, but many stable patients could benefit.

We've already introduced the option of prescriptions lasting up to twelve months where clinically appropriate. We should also allow pharmacists to undertake funded medication reviews, order appropriate blood tests, and manage routine monitoring, with information shared with the patient's GP. Doctors remain responsible for the wider clinical picture. They should have more time for the complex cases that need their judgement.

A third part of the policy is earlier identification of health risks. New Zealand has one of the highest melanoma rates in the world. Trained pharmacists could take and securely record images of suspicious skin lesions, use approved technology to help assess risk, and refer concerning cases for diagnosis. It would be a triage service, easing pressure throughout the health system.

We would also remove unnecessary restrictions on opening pharmacies, extend licence renewal periods, and allow secure prescription collection lockers for suitable medicines.

There must be clear standards for training, referrals, shared records, and clinical safety. Those are manageable questions and can be worked through.

Giving pharmacists a wider role makes care easier for patients, improves the use of existing skills, and frees GPs to see the people who need them most. That is a better answer than assuming every access problem requires more administration or money.

Successive Governments have neglected primary care, and now the hospitals are overloaded. I wonder if the problem is that pharmacies and GP clinics are private businesses, out of favour with the Wellington bureaucracy and most politicians.

Closing the gap

Now, much of that is about stopping people getting sicker. But no matter how good we become at prevention and early treatment, some New Zealanders will be dealt a cruel hand. They will develop cancer, a rare disease, or another serious condition.

As Minister responsible for Pharmac, I have heard from hundreds of people who know a treatment exists but cannot get it. Some have been told their medicine is funded in Australia. Others know Pharmac has assessed it and placed it on the Options for Investment list, but has no funding left to pay for it.

These are among the hardest letters I receive. You cannot give a patient and their family their time back with an explanation about the budget.

New Zealand spends just 4.9 per cent of its health budget on medicines. Australia spends 12.2 per cent. The OECD average is 13.3 per cent. Australia funds 142 modern medicines that New Zealand does not, and 38 per cent of those are cancer medicines.

Those figures should bother us. Pharmac is good at assessing medicines, negotiating hard, and getting value for money. But Pharmac has been expected to produce first-class results on an economy budget. Look at this year's Budget. Health received around $1.5 billion in new funding, while Pharmac received $13.5 million. Under ACT's approach, Pharmac would have received around $320 million more, with substantial additional funding still available for the rest of health.

ACT has proposed we increase the share of the health budget spent on medicines by one percentage point each year until we reach Australia's level in 2033. The funding would come from expected future increases to the health budget. It would not require a new tax or cuts to the existing health budget. It is a choice to give medicines a higher priority as health spending grows. I think it would be among the best money we could spend, and the impact it would have on people’s quality of life and future prosperity will lead to it paying for itself.

I’ve heard other parties speak of the importance of medicines funding. It is an area where there is consensus. ACT has a realistic plan and I really hope we can get our colleagues, both in the coalition and across the aisle to support this.

World-class cancer centre

Our ambition for world-class cancer care goes beyond buying the medicine. Treatment is another reason people cross the Tasman,

More than 30,000 New Zealanders are diagnosed with cancer each year. Around a thousand more people die annually than would if our cancer mortality rate matched Australia's.

ACT has proposed a National Cancer Centre, with major campuses in Auckland and Christchurch, bringing specialist care, research, advanced technology, and clinical trials together. We have set aside around $2 billion as a funding contingency in our fiscal plan, alongside potential private investment and philanthropy.

Starship showed what New Zealand can achieve when we concentrate extraordinary people, technology, generosity and national ambition around a single mission. This will be much bigger.

We want to build an institution capable of standing alongside the best in Melbourne, London, Toronto and anywhere else in the world. Somewhere like the Peter MacCallum Cancer Centre in Melbourne.

A genuinely global centre of excellence gives brilliant New Zealanders a reason to stay and brilliant people overseas a reason to come here.

It is the kind of long-term investment that could help attract and keep talented clinicians, give patients access to trials, and build an institution New Zealanders can be proud of. It would require a proper business case. Ambition must be matched by discipline.

ACT will establish an independent philanthropic foundation from the beginning of this project to unlock extraordinary generosity, with major donors recognised through naming rights for appropriate parts of the Centre.

And if somebody makes a truly transformational contribution and wants their name on the hospital, put their name on the hospital. Print the letters in enormous font.

The recently introduced $33,333 cap on the tax benefits available for charitable donations will be removed by ACT for all charitable giving. If New Zealanders want to give $1 million, $10 million or $100 million to cancer care, the system should encourage that generosity, not impose an arbitrary ceiling on it.

Future of health

The future of New Zealand’s health depends on a few things. Can we afford the future and get more of the medicines that make a difference? Can we use our trained professionals better? Can we make sure that New Zealand has the facilities that make them want to stay?

If we can answer these questions, then New Zealand has a healthy future.

I truly believe ACT has the answers. Empowering and boosting primary care to take the pressure off parts of the system that are creaking, funding medicines in a gradual way that means we close the gap with Australia, a world-class cancer centre that makes the best in the world want to work here.

All of these are completely realistic.

A stronger ACT voice in the next Government will mean making these changes faster, putting patients first, and fixing what matters in healthcare.

That's the future of health ACT is working toward.

Thank you.