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Dunne: Medical Law conference

Speech by Associate Health Minister Peter Dunne
Embargoed to 11am, Wednesday, April 23
Medical Law conference
Wellington Town Hall

Good morning and thank you for the opportunity to address you on the topic of our Medicines Strategy.

Why have one, you may ask? After all, medicines are a common feature of our everyday lives, and a vital component of our health and disability system. They’re so common, everyone knows what they do and where to get them, don’t they?

Well, times are changing, rapidly, and as a result of negotiations between my party and the Labour-led Government we’re now carrying out a major review of exactly how this country deals with medicines.

Getting the best outcomes from medicines requires robust systems and structures. Our medicines sector is a robust one, with a large number of agencies and stakeholders carrying out a lot of good work – but there is always room for improvement.

The context of health care is changing. The regulation of health practitioners has changed to encourage more flexible use of practitioners’ skills, and with this change has come the extension of prescribing rights to new groups of health practitioners.

Primary Health Organisations (PHOs) provide new care delivery settings, focused on teams and low-cost access to primary health care. Users of health and disability support services are also becoming better informed about how to care for their health and potential treatment options available.

Developing Medicines New Zealand presented a timely opportunity to step back and ask New Zealanders what they want from our medicines system, and to consider how we could take advantage of the changes occurring in the health and disability support system.

It allowed us to examine, and consumers and other stakeholders to share their views on, how well our current system is working and to identify where improvements could be made.

The genesis of Medicines New Zealand was the recognition that there was no overarching policy direction to guide our medicines sector and the systems that govern the regulation, procurement, management and use of medicines.
Parts of the sector, including industry, had been seeking a strategy for some years. Further impetus came in 2005 as a result of the Confidence and Supply Agreement between the Labour-led government and the United Future Party.

The fruits of these efforts were realised in late 2007 when, with great pleasure, I released Medicines New Zealand and its accompanying action plan Actioning Medicines New Zealand.

Perhaps the most important thing that Medicines New Zealand does is to articulate a shared view of the outcomes we want from our medicines system and the principles that will guide decision-making within it.

For the medicines sector, Medicines New Zealand provides a strategic platform to draw the sector together; informing decision-making over the long term and ensuring New Zealanders have a world-class medicines system.

Medicines New Zealand identifies three outcomes for New Zealanders from our medicines system:

- quality medicines that are safe and effective;
- access to the medicines they need; and
- that medicines are used effectively.

I will talk more about these in a moment. First I want to briefly touch on the principles that underpin decision-making in the context of Medicines New Zealand.

Our medicines system is made up of a broad range of agencies and stakeholders carrying out diverse functions, from medicines regulation and adverse reactions monitoring, to dispensing medicines and research.
It would be difficult for one agency to deliver all the functions necessary in a medicines system. This spread of functions, while providing necessary checks and balances, also presents us with some challenges.

Medicines New Zealand is a high level strategy; it does not and cannot foresee every policy decision that will be made in relation to medicines. Instead it offers a set of principles that will guide decision-making across the sector.

The six principles: equity; effectiveness; confidence; value for money; affordability and transparency, are to a large degree intuitive and foreshadowed in existing aims for the wider health sector.

The inclusion of transparency as a stand-alone principle responds to comments made during the submissions process and is reflected in a number of the initiatives outlined in Actioning Medicines New Zealand. The initiatives include a commitment to publish summaries of medicines funding decisions and extending the audit provisions in the Health Act 1956 to support further monitoring across the medicines system.

Returning to again to the outcomes we want from our medicines system, let me begin with access.

Access to medicines is probably what most New Zealanders think about when they think about our medicines system. Medicines New Zealand defines access as New Zealanders having access to the medicines they need, regardless of their individual ability to pay, and within the funding provided.

The Pharmaceutical Schedule is comprehensive and also provides New Zealanders already have access to some of the cheapest medicines in the world.
PHARMAC has been highly successful in securing cost-effective medicines for New Zealanders. In 2005 the Australian government revealed that some medicines cost New Zealand taxpayers as much as 19 times less than they cost Australian taxpayers.

Access to medicines, however, is about more than just their direct cost. Access to medicines is also influenced by the cost of visiting a General Practitioner (GP) and prescription charges.

There is little use in having affordable medicines if those most in need cannot meet the costs of accessing their GP or paying the cost of the prescription.

The Primary Health Care Strategy recognises this through significant reductions in the costs of both GP visits and prescriptions costs ($3 if you are enrolled in a Primary Health Care Organisation).

Health care resources are finite; choices have to be made about how they are best used. These are complex decisions.

The challenge of weighing investment in medicines against investments in other health services is discussed and debated internationally.

Actioning Medicines New Zealand responds to this challenge and signals a commitment by PHARMAC and District Health Boards, together with the Ministry of Health, to move toward a principles-based approach for setting the community pharmaceuticals budget.

Prioritisation decisions need to be transparent so that people can have confidence in decisions and know what is taken into account when a decision is made. Stakeholders, including consumers, should have opportunities to have input into the decision-making process.

Medicines New Zealand recognises this and Actioning Medicines New Zealand responds. Initiatives such as regular fora by the Ministry of Health and PHARMAC are intended to provide opportunities for citizens to have input into broader thinking about the medicines system.

There will also be increased opportunities for input into specific medicines funding decisions along with guidance on how to participate.
Our regulatory system delivers safe and quality medicines to New Zealanders, but we know the current arrangements fall short of the vision of “a sustainable, efficient and effective regulatory system, consistent with international best practice” described in Medicines New Zealand.
Government’s preferred option remains the Australia New Zealand Therapeutic
Products Authority and the implementation of the joint regulatory scheme. A current lack of support for this in the House means this is on hold while further thought is given as to how best to proceed.

Making the best use of – or as Medicines New Zealand describes it – ‘optimal use’, means ensuring that choices about medicines, how the system delivers medicines and how individuals use medicines results in the best possible health gains from medicines.

Optimal use activities are often an under-appreciated element of the medicines system. This is, however, an area where real gains can be made.
There are already many exciting things happening in this area, across our hospitals and in our communities.

Our challenge is to bring innovative ideas together to share information about what people are doing and what has been learned. Actioning Medicines New Zealand commits to exploring how we can work with existing structures to create a formal mechanism that supports a cohesive approach to best use of medicines practices.

Changes in the health and disability sector create opportunities to take innovative new approaches to utilising the skills of health practitioners to improve access to, and use of, medicines.

In particular we need to ensure that disadvantaged groups such as Maori, Pacific peoples and low-income people are getting improved outcomes from medicines as other New Zealanders.

The regulation of health practitioners under the Health Practitioners Competence Assurance Act 2003 encourages more flexible use of health practitioner’s skills.

Capitalising on this, Actioning Medicines New Zealand identifies initiatives relating to prescribing rights.

This includes exploring amending the Medicines Act 1981 to give nurse practitioners and optometrists the same prescribing rights, within their scope of practices, as currently available to medical practitioners, dentists and midwives; and amending the Medicines Act 1981 to create a new class of prescriber called a ‘collaborative prescriber’, to allow non prescribing practitioners to prescribe medicines under the direct authorisation of a medical practitioner, dentist or midwife.

This also includes looking at the way we use the skills of pharmacists and exploring innovative ways to deliver pharmacy services. Work on this is already underway and, together with pharmacists, we are thinking about what more can be achieved into the future.

Recent reports on adverse events in hospitals highlight the need to continually think about how we can improve the way we deliver health care services.
Technology offers us new ways to deliver medicines and reduce the risk of errors. Actioning Medicines New Zealand is committed to developing a national programme to reduce the rate of errors in medication management.

This will include the introduction of standardised inpatient medication charting, electronic prescribing and the use of bar-coded point-of-care systems to ensure the right patient receives the right medicine at the right dose and the right time.

Consultation is currently underway on the Pharmacology and Therapeutics Advisory Committee (PTAC) appointment protocol. Further consultation is expected in 2008 on other Actioning Medicines New Zealand initiatives.

No one can do this alone. Medicines New Zealand signals a new climate for consultation and collaboration across this diverse sector.

Medicines New Zealand acknowledges these different perspectives, while still offering a common platform to work together to bring about the best health outcomes possible through medicines.

Thank you.


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