What next for Pharmac boss after 'sick, sneering' remarks about Rachel Smalley?

Wednesday, 8 November 2023

Pharmac’s CEO has managed to survive scrutiny from her board over sneering remarks made about broadcaster Rachel Smalley, but patient advocates hope a new government will make changes.

Pharmac is the government agency which decides which medicines and related products are funded in New Zealand.

But patients say it is massively underfunded, leading to New Zealand being at the bottom of the OECD for medicine access, and has a toxic culture where it is a law unto itself.

That culture was laid bare in a 274-page Privacy Act release to Smalley, a journalist and medicine advocate, where staff celebrated her radio station Today FM closing and boasted about making her cry with relief over a drug being funded.

Chief executive Sarah Fitt was even found to be involved, writing “Sigh…” as an email subject, when forwarding a link to an article by Smalley about cancer patients who would have died if they relied on the public system.

Patient advocates around the country called for Fitt to resign or be sacked over the comments, which were called “sick and sneering” and a show of contempt.

Fitt apologised for the comments, telling her board they were isolated and not reflective of Pharmac’s culture.

In a board meeting on October 27, the board accepted Fitt’s apology and agreed to an action plan to improve that culture.

A Pharmac spokesperson said the agency is seeking an external party to help with its culture, while Fitt and board chair Steve Maharey have spoken to all staff.

“We are updating our induction for all new staff and external advisors to ensure a stronger focus on our responsibilities as public servants,” the spokesperson said.

But Smalley said the flippant and combative nature shown by Pharmac shows it needs more than just external consultants to tell them how to be nice.

She would like to see changes at the top to genuinely make a culture change, saying those who oversaw the culture cannot now change it.

Smalley, who founded The Medicine Gap to highlight New Zealand’s lack of drug funding compared with other countries, said Givealittle has now become a platform for survival for those needing medicines.

She would like recommendations from a 2022 Pharmac Review to be implemented, including the agency being more integrated with the rest of the health system.

“If you don’t understand the areas where there’s a significant health burden, then how can you be making the decision about what to fund and what not to fund?”

Patient Voice Aotearoa chair Malcolm Mulholland agreed Pharmac’s action plan is not enough and said new leadership – including new CEO and new board – is needed.

“We know they come with a long history of treating patients and advocates with contempt.”

The problem with Pharmac is not only that it has been historically underfunded, but no one is accountable for its actions, Mulholland said.

Instead of focusing solely on its budget, Pharmac needs to look at the societal impact – to both patients and their families – of not funding drugs.

Mulholland is hopeful a National-led Government will be open to changes, with both National and Act criticising Pharmac during the 2022 review and National promising more funding for cancer drugs.

New Zealand First has gone one step further, calling for Pharmac to be replaced with a more patient-focused agency similar to Australia, where the Minister of Health is more accountable for its decisions.

“I don’t think patients will have a problem with that.

“I think it’s really interesting to see what coalition talks will come up with for Pharmac.”

National declined to comment, saying it first needed to form a government and appoint ministers before putting policies and plans in place.

Chris Higgins, chief executive of Rare Disorders NZ, is also calling for leadership changes at Pharmac, including for Maharey to be removed as board chair for not making the CEO more accountable for her actions.

Fitt’s apology did nothing to address those who felt most offended by her remarks – those who are being denied access to the medicines which would improve the quality and lengths of their lives, he said.

Higgins also believed more of the recommendations made in the 2022 Pharmac Review should be implemented but he said one recommendation – for New Zealand to develop a rare diseases strategy – is being worked on.