Ministers announced the Government’s $604 million health budget to honour a National pre-election promise. Video / Mark Mitchell
Analysis by Derek Cheng
Derek Cheng is a Multimedia Journalist for New Zealand’s Herald. He values holding those in power to account and shining a light on issues kept in the dark.
The National Party promised to fund 13 cancer drugs in the election campaign starting in 2024/25, but failed to deliver this in Budget 2024.
Emails released under the Official Information Act show the paucity of policy work towards delivering this promise for Budget 2024.
The post-Budget backlash was so strong that a Cabinet paper was delivered within a week, with an announcement delivering funding for the treatments - and more - within a month.
It was a political risk not to reveal beforehand that the cancer treatments funding was being pushed to 2025, which arguably contributed to the magnitude of the backlash when that failure was revealed on Budget day.
Emails and correspondence released under the Official Information Act reveal the Government did very little to investigate delivering the promise on the timeline it said it would.
No Cabinet paper on the policy was produced before Budget day, and most of the correspondence between ministers’ offices and Pharmac on National’s election pledge was about media inquiries, rather than policy development.
That all changed rapidly in early June, when officials worked around the clock to meet ministerial demands for a draft Cabinet paper and detailed policy analysis within days.
This leaves the Government exposed to allegations it could have delivered earlier, but Finance Minister Nicola Willis says a decision was made to do it for Budget 2025.
Nicola Willis, National Party, Budget 2024. Illustration / Guy Body
The Herald asked for all correspondence and official advice between Pharmac and the office of any minister regarding the pledge to fund the cancer drugs, as well as any such correspondence to and from the office of Pharmac chief executive Sarah Fitt.
The results returned nothing in the first six weeks of the Government’s term. The first such document was on January 8 - an email with the subject line “Budget - Pharmacy - 13 Cancer Drugs” from Te Whatu Ora to Pharmac asking to set up a discussion in the next few days.
Email silence followed for two months until March 5, when two media inquiries landed after a podcast episode featuring oncologist Chris Jackson talking about the Government’s pledge.
In response, Pharmac drew up a list of the status of the 13 cancer drugs - most of them were on the Options For Investment (OFI) list) – which was updated on May 24 at the request of Health Minister Shane Reti’s office.
That was less than a week before Budget day, probably in anticipation of questions about whether National would deliver on its election promise.
By then Reti’s office was already preparing for a possible backlash, having sought assurances from Pharmac for some lines for Prime Minister Christopher Luxon’s post-Cabinet press conference on May 20. Those lines included the Government being “fully focused” on improving cancer treatment – a standard line when there is nothing substantive to say.
Luxon didn’t field any questions about the cancer drugs promise in that press conference but it was a different story a week later, when Finance Minister Nicola Willis fronted alongside Luxon.
“I’m not making an announcement about that today,” was Willis’s repeated response to several questions about whether Budget 2024 would deliver National’s promise on cancer medicines.
The lack of correspondence between ministers and officials about the cancer drugs promise doesn’t mean that no work was being done.
An initial briefing was written up in December with an analysis of the options, but no Cabinet paper came from it. Reti said today that informal discussions also took place.
“Patients don’t have a year to wait and will sadly have to look at all the heartbreaking scenarios your party wanted to put an end to,” the letter said.
Pharmac chief executive Sarah Fitt was working on King's Birthday in anticipation of the Government wanting urgent action to deliver its promise on funding cancer treatment. Photo / Supplied
The first Monday after the Budget was a public holiday but that didn’t stop Maree Roberts, deputy director-general at the Ministry of Health, from sending an email to officials at Pharmac, the Treasury and Health NZ/Te Whatu Ora about the need for an urgent Cabinet paper on the matter.
“The Minister has requested a Cabinet Paper by the end of the week covering all options including their costs. We had already presented a paper on options [in December], so we will be updating and converting to a Cab Paper,” her email said.
She wasn’t the only one working on King’s Birthday. Fitt was forwarded the email at 5.19pm, to which she replied: ”Thanks, have been going through it all today as was expecting this.”
The following morning, Ministry of Health policy manager Stacey Connor wrote to several officials about the December briefing, titled “Options to progress the additional cancer treatments initiative”.
This preceded an email from Reti’s office, following a one-on-one meeting between the minister and the director-general of health Dr Diana Sarfati. That meeting led to a further email from the ministry to Pharmac stressing that another option should be looked at - which Cabinet eventually adopted.
A flurry of correspondence between Fitt and other Pharmac officials ensued. Pharmac’s director of strategy, policy and performance Michael Johnson sent through the previous analysis (redacted in the document) of that option with the comment: “We don’t have the time I guess to update.”
A couple of hours later he emailed the ministry with Pharmac’s reckons on the option, including a redacted amount of funding over four years for the CPB (combined pharmaceutical budget). “In addition to these treatments for cancer, other medicines could be funded,” he said.
The option of buying the 13 cancer drugs outside of Pharmac was still being considered at that stage, but shrouded in uncertainty over how much it would cost.
Associate Health Minister David Seymour has responsibility for Pharmac. Photo / Mark Mitchell
That evening Reti, Willis and Associate Health Minister David Seymour, who has responsibility for Pharmac, held an urgent meeting.
Seymour’s office sent an email the following morning asking for information “as soon as possible”, including whether National’s initial cost estimate of $280m would cover all 13 cancer drugs, and what the impacts would be on the health system.
“This info request is being driven by the Minister following last night’s tri-Minister meeting,” Seymour’s private secretary said in the email. “The main concern of the office is that they have a vision on how they want to take Pharmac forward (as outlined the other week) and don’t want to compromise on it.”
A draft Cabinet paper was delivered by Thursday morning, two days after officials starting putting it together.
Reti’s office asked for a separate paper the following day that included more detail on each of the treatments being purchased.
This led to a series of emails between Fitt and Johnson, with the latter commenting at one point: “I am struggling a wee bit with what more information we could provide apart from high-level generic info eg implementation phasing and timing to be worked through. We cannot provide a breakdown of cancer v non-cancer proposed expenditure due to commercial sensitivies??….”
It included seven of the 13 cancer medicines in National’s election promise, with a promise that the others would be replaced by alternatives just as good or better.
Finance Minister Nicola Willis. Photo / Mark Mitchell
Willis defends not acting sooner
This morning Willis defended the decision not to push ahead with the original promise in Budget 2024.
She said the December briefing didn’t include details about “how many cancer drugs, how many other drugs would be funded, what the implications were, how many patients would be reached, what that would look like”.
The detailed policy work required to implement the policy didn’t come until after Budget day, she said. Asked why that hadn’t happened earlier, she said Reti had decided not to progress it in Budget 2024.
However, Reti said there was enough information in the December paper to include the policy in Budget 2024.
“I think we did [have adequate information]. I think we had the initial scope of what was in the mix, and then we were deciding which of those would stand up the best.”
Willis said the immediate challenge for Budget 2024 was to fund Pharmac to continue business as usual, so the cancer medicines policy was pushed to 2025.
“We could have left it until May next year at the announcement of the next Budget, but we decided to bring it forward because we heard very clearly from cancer patients at the time of the Budget that they were disappointed by the timing.”
Willis had sent Reti a text the day after Budget day “because I wanted to see rapid action”.
“I knew that we needed to get an answer for New Zealanders as soon as possible. One of my reflections immediately after the Budget was [that] I want to make sure that we have a solution for that one quickly.
“We made a political decision to fund not only 26 cancer drugs but an additional 20 drugs because we decided that that was the right thing to do. And as a consequence, more than 175,000 New Zealanders will benefit.”
Derek Cheng is a senior journalist who started at the Herald in 2004. He has worked several stints in the press gallery team and is a former deputy political editor.
