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Herceptin and Road Safety Trials

Herceptin and Road Safety Trials
Candor Trust Media Release

The Candor Trust road safety charity is concerned the Judicial Review Panel's decision, affirming the propriety of the New Zealand Government providing short term breast cancer treatment with Herceptin as opposed to funding full treatment courses, wasn't based on full information. It bodes ill for similar appeals in relation to road safety decisions.

The judiciousness of Pharmacs decisions in relation to herceptin provision was challenged, yet Pharmac has parameters set around the decisions it may make, due to criteria set by higher level agencies. In both health and road safety areas policy trials of great import and significant risk are being run down under, under the umbrella of the State Pathfinders project (applied macro economic theory pilot).

Trust Spokeswoman Rachael Ford says "the Court considering the Herceptin appeal has set a bad precedent by giving the nod to ongoing testing of an experimental resource allocation model that can be seen to impact on life chances".

Candor believe the same test run corner-stone policy behind the Herceptin treatment oddity at Pharmac medicine funding agency is also responsible for New Zealands outlandishly non evidence based road safety program. Another policy oddity, again conspicuous within the OECD policy stable for it's lack of evidence bases.

The abnormal resource allocation decisions (for a first world economy) being made in the NZ health and road safety sectors come back, say Candor, to State Service "Outputs" (prioritised State activities) being tied to a maximum of only 3 permitted focuses for any Government Department, as per the Pathfinders policy project manuals and guides for NZ Bureaucrats.

The NZ State Services Commission publication "Pathfinder Building block 1: Identifying Outcomes specifies the "vital few" outcomes as the core (3 or less) outcomes that:
• are well aligned with the agency's (or business unit's) mission or purpose;
• are tangibly linked to outputs and inputs (the things an agency manages);
• can be measured using reliable data, obtainable at a reasonable cost.

In Road Safety management the "vital few" issues that attract Treasury funding (without great impact) are reduced speed, drink driving and seatbelt disuse, and the requirement is to supress other issues. For the Health portfolio the vital few have been defined within State Service Commission Documents as reduced smoking, cardiovascular disease and diabetes. Breast or any cancer is not a key performance indicator - so gets short shrift.

"Outputs" are defined as the results targeted from various efforts to achieve the final outcomes also known as the "vital few." For example, lower speeds on highways or lower average fat consumption will be achieved. Anecdotally, lobby groups are claiming New Zealand has seen excess effort put into "vital few" related outputs - while other obvious priorities and past priorities are relegated to the scrap heap.

The covering letter to Chief Executives for the 2003/04 roll-out of State Owned Enterprises states "you will not be held accountable for achieving outcomes, you will be held accountable for 'managing for outcomes'". The covering letter is explicit about the accountability of chief executives: "you will still be held accountable for delivering outputs and for altering your mix of outputs as circumstances dictate".

According to the State Services Office, Chief Executives will be held accountable for the delivery of outputs, and for the selection of outputs, without compromising Ministerial expectations. They have no power to select the vital few priorities, and are therein slaves to Treasury monitors. Treasury Pathfinder papers give Officials a "bum steer" by advising that the selected outcomes should always support critical business and resource decisions.

Jackie Blue (National Party) needs to track this blinkering of Pharmac back to Pathfinders say Candor. Not least because the dominance of the "vital few" across many sectors is creating an overabundance and resource wastage in targeting some issues, while others that are quite deserving have had the purse strings pulled so tight as to be obviously unjust.

The Pathfinders website advises that mistakes may be made but should be viewed as a learning experience. Prime examples of the Pathfinder folly come from the health and road safety arenas. The odd approach is often exemplified in such cases as Government failing to fund realistic courses of herceptin treatment (perhaps seen as locking the stable after the horse has bolted), while millions are spent providing free nicotine chewing gum to smokers with no diagnosed cancerous or other condition.

Candor Trust assert the high potential for misfired and unjustly apportioned funding, as part and parcel of the Pathfinders project, seems to create tension with the NZ Bill of Rights Act; on "right to life" or "scientific experimentation" grounds. Interest groups affected by the Pathfinders "vital few" directive may do best to fight for resource recognition for any of their issues which have a wide public interest with a united front.


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